What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?

Abstract

Purpose of ReviewIn spite of the increasing prevalence of severe and complex obesity in children, surgery as a potential management option is still not widely accepted. The purpose of this review is to examine the evidence for surgical options in the severely obese paediatric population. Increasing evidence supports early rather than later use of bariatric surgery in the treatment of extreme obesity.Recent FindingsPrior to 2007, the feasibility and safety of surgery have been reported by predominantly small, sporadic single-centre retrospective case series. Increasing long-term data is now emerging due to the formation of multi-centre prospective national consortiums with two large, prospective long-term outcome studies published within the last year aiding our understanding of the efficacy and safety of bariatric surgery within the adolescent population.SummaryIt is increasingly clear that adolescent bariatric surgery outcomes are comparable to adults, with similar sustainable weight loss, resolution of co-morbidities and complication rates. However, these studies are solely from dedicated specialist adolescent centres and results may not be reproducible if not performed in regulated environments with specialist multi-disciplinary teams.

Current Opinions and Practices of Bariatric Surgery in Adolescents: A Survey among Pediatric Surgeons

“…8 Bariatric surgery is considered safe and effective by many to obtain substantial weight loss and resolution of associated comorbidities. 9,10 Despite the favorable results of bariatric surgery in the literature, implementation of this treatment shows a large variety worldwide. While numbers of severely obese adolescents undergoing bariatric surgery in the United States are increasing, surgeons in Europe seem more reluctant to perform such procedures.…”

Childhood obesity: Aetiology, comorbidities, and treatment

“…The evidence in this population group is limited, and more epidemiological studies are needed to highlight the main benefits and their impact in the short and long term . A Cochrane systematic review of 2015 regarding the role of bariatric surgery in adolescents indicated that this intervention, independently of surgical techniques, had beneficial results in some comorbidities of obesity such as dyslipidemia and type 2 DM and a positive impact on the quality of life of the paediatric patient . The use of vitamin supplements is recommended because in the absence of these, inadequate absorption of calcium, vitamins A, C, and D, iron, and vitamins B1, B6, B9, and B12 can occur, which can lead to nutritional deficiencies and clinical symptoms of peripheral neuropathy (B12 deficiency), beriberi syndrome (B1 deficiency), iron deficiency anaemia, osteopenia, or osteoporosis .…”

“…The use of vitamin supplements is recommended because in the absence of these, inadequate absorption of calcium, vitamins A, C, and D, iron, and vitamins B1, B6, B9, and B12 can occur, which can lead to nutritional deficiencies and clinical symptoms of peripheral neuropathy (B12 deficiency), beriberi syndrome (B1 deficiency), iron deficiency anaemia, osteopenia, or osteoporosis . The monitoring of the paediatric patient at the metabolic and psychosocial level must be guaranteed for at least 2 years after surgery …”

Weight Loss Surgery Utilization in Patients Aged 14–25 With Severe Obesity Among Several Healthcare Institutions in the United States

“…Severe obesity is defined as a BMI ≥ 99th percentile for age and gender, equivalent to a BMI Z-score of +2.5, which is an adult BMI of 30 kg/m 2 ( 4 ). A high BMI for age, especially in those with severe obesity, is associated with early co-morbidities, such as type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), dyslipidemia, obstructive sleep apnea (OSA), hypertension (HTN), heart disease, and early mortality.…”

“…Obesity is the most significant threat to the health of younger generations due to its cumulative health impact ( 4 ). Current indications for WLS in adolescents include a BMI ≥35 kg/m 2 or ≥120% of the 95th percentile with clinically significant comorbid conditions such as OSA (apnea-hypopnea index (AHI) >5 events/h), type 2 diabetes, idiopathic intracranial hypertension, NASH, Blount's disease, slipped capital femoral epiphysis, gastroesophageal reflux disease or HTN; or BMI ≥40 kg/m 2 or ≥140% of the 95th percentile ( 6 ).…”