Ten-Year Outcomes of Children and Adolescents Who Underwent Sleeve Gastrectomy: Weight Loss, Comorbidity Resolution, Adverse Events, and Growth Velocity

Abstract

Background To date, there are insufficient data on long-term outcomes of weight loss surgery in children and adolescents with obesity beyond 5 years of follow-up. This study aimed to analyze durability of weight loss and comorbidity resolution, growth velocity, and adverse events associated with laparoscopic sleeve gastrectomy (LSG) in children and adolescents with severe obesity. Study Design In this prospective cohort study, 2,504 children and adolescents with class II/III obesity who were enrolled in a multidisciplinary, family-based pediatric obesity management program underwent LSG between 2008 and 2021. Weight loss, growth, comorbidity resolution, and adverse event data during the first 10 years after LSG were analyzed. Results The cohort age was 5 to 21 years at the time of operation, and 55% were female. Mean ± SD percentage of excess weight lost during short- (1 to 3 years; n = 2,051), medium- (4 to 6 years; n = 1,268), and long-term (7 to 10 years; n = 632) follow-up was 82.3% ± 20.5%, 76.3% ± 29.1%, and 71.1% ± 26.9%, respectively. Complete comorbidity remission at long-term follow-up was observed in 74%, 59%, and 64% of type 2 diabetes, dyslipidemia, and hypertension cases, respectively. Mean ± SD height z-score change at short-, medium-, and long-term follow-up was 0.1 ± 0.5, 0.1 ± 1.2, and 0.0 ± 0.8, respectively, representing no significant change in growth velocity. There were 27 adverse events (1%) with no procedure-related mortality. Conclusions Long-term follow-up after LSG in children and adolescents demonstrates durable weight loss, maintained comorbidity resolution, and unaltered growth. Visual Abstract

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery

“…Furthermore, data suggest that the benefits of RYGB on T2D and hypertension are greater in adolescents than adults [52][53][54][55]. Prospective data shows durable weight loss and maintained co-morbidity remission in patients as young as 5 years old [56].…”

The Role of the Gut Microbiome in Pediatric Obesity and Bariatric Surgery

“…VSG also leads to weight loss through delayed gastric emptying and altered neurohormonal feedback mechanisms [ 25 , 26 ]. VSG is now the most common bariatric procedure in both adults and adolescents [ 19 , 23 , 25 ], and VSG is currently the only type of bariatric surgery used in children younger than 13 years of age [ 27 ]. Laparoscopic adjustable gastric banding (LAGB) is performed with a device that can be easily removed, but its use is limited by the FDA to patients aged 18 years and older [ 19 , 28 ].…”

“…Alqahtani et al studied the largest cohort to date of children and adolescents undergoing weight-loss surgery, with 2504 participants undergoing VSG over 10 years. Their group showed durable weight loss and maintained comorbidity resolution [ 27 ]. They were also one of the few groups to measure vertical growth over time; patients reassuringly had unaltered growth, which is of particular concern in the pediatric population [ 27 ].…”

“…Their group showed durable weight loss and maintained comorbidity resolution [ 27 ]. They were also one of the few groups to measure vertical growth over time; patients reassuringly had unaltered growth, which is of particular concern in the pediatric population [ 27 ]. However, it is important to note that long-term data was limited to approximately 25% (632 patients) of the entire cohort [ 36 ].…”

Nutritional Management in Bariatric Surgery Patients

“…However, in this age group, it is still underused [41]. A 10-year follow-up showed high efficacy on the weight loss and resolution of comorbidities (hypertension, type 2 diabetes, and dyslipidaemia) in most of the children and adolescents that underwent sleeve gastrectomy (SG), without alteration of growth or other safety concerns [42].…”