Laparoscopic sleeve gastrectomy in adolescent; pros and cons
EAES Academy. Abdelgawad M. 07/05/22; 362965; P008
Dr. Mohamed Abdelgawad
Contributions
Contributions
Abstract
Introduction:
Obese adolescent will grow in the future to obese adult with increasing burden on health care systems. Many contributing factors result in obesity such as individual, dietary, social, behavioral, and environmental factors.
Multidisciplinary approaches were introduced in the previous studies for management of adolescent obesity. Non-surgical weight loss strategies like life-style modifications, physical exercise and dietary control have been crucial in obesity management; however, they have disappointing results. Pharmacological therapy has limited effect on weight control and long-term data is scarce. Consequently, growing interest emerged on the surface to obesity surgery for adolescent. Weight loss surgery remains the main stay and effective treatment for obesity and can result in loss 58% to 73% of excess body weight. Its efficacy had been proven for long-term weight control and control or even eliminating the obesity-related co-morbidities in adults.
The adolescent bariatric surgery gained popularity in the last decade with increasing number of cases worldwide. Promising results from previous studies showed major improvement in co-morbidities, psychological issues, and obesity-related mortality after surgery. On the other hand, there are many concerns regarding the ethical considerations, and surgery-related complications. More-over, long-term data after surgery including quality of life, pathological eating behavior and weight regain is rare in the literature.
Different surgical techniques such as sleeve gastrectomy, gastric banding, and Roux-en-Y gastric bypass had been evaluated regarding efficacy, safety and feasibility showing controversial results between different centers. High quality evidence such as randomized control studies, systematic reviews and meta-analysis regarding the safety of adolescent bariatric surgery is still deficient in the literature. And so, we conducted this study to assess the feasibility, safety, and short and long-term effects of laparoscopic sleeve gastrectomy for treatment of adolescent obesity.
Patient and methods:
This was retrospective study to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in obese adolescents. This study was carried out in Gastrointestinal Surgical Center, Mansoura University, Egypt. The patients’ data was collected from the prospectively maintained database in our center between 2014 to 2019.
Inclusion criteria
All adolescents aged from 12 to 20 years with body mass index (BMI) more than 40 kg/m2 or BMI higher 35 kg/m2 associated with obesity-related comorbidities were included in the study. The co-morbidities should be documented by the treating pediatrician or specialized referring physician. All eligible adolescents underwent non-surgical weight loss management such as lifestyle modifications, physical exercise, and dietary control but with unsatisfactory results within a minimum period of 12 months. Awareness of the adolescent and his or her family about the possible perioperative complications and the adherence to strict follow up program and dietary regimens.
Exclusion criteria included: eating disorders, lack of social family support, developmental immaturity, severe and uncontrolled cardiorespiratory disease, syndromes causing obesity (Prader Willi syndrome), and endocrinal disorders affecting the weight loss such as untreated hypothyroidism and prolactinoma. Patients with history of upper GI surgery were also excluded.
All patients underwent comprehensive evaluation by specialized team consisting of pediatrician, dietitian, bariatric surgeon, and psychologist before operation. Routine laboratory investigations and abdominal ultrasonography were routinely done. Upper GI endoscopy was done for patients complaining of GERD symptoms.
Standard 5-port LSG was done over size 40 fr bougie starting 4 cm proximal to pylorus was done using EndoGIA stapler (Johnson and Johnson or Covidien).
Follow up visits were scheduled at the outpatient clinic 2 and 4 weeks after surgery then 3, 6, 12, 18, and 24 months, then yearly. All patients were evaluated for excess weight loss, dysphagia, vomiting, eating behavior, comorbidity improvement, and any other complications.
Results:
Forty patients were included in the study; 18 male (45%) and 22 female (55%) with median age was 17 years (range, 14 – 20). Mean preoperative body weight (BW) and BMI were 147.15 ± 36.31 kg and 52.55 ± 11.61 kg/m2 respectively. All patients had at least one co-morbidity. Osteoarthritis was the most common obesity-related co-morbidity in the study cohort (14 patients, 35%). Four patients presented with GERD symptoms, of which 2 patients underwent upper GI endoscopy before surgery to confirm diagnosis. No syndromic obesity was identified in the study cohort.
Mean operative time was 119.25 min. Reinforcement of staple line was indicated in four cases. Intraoperative complications encountered during surgery were 2 patients with staple line bleeding controlled by clipping of the bleeding vessels and 2 stapling failure managed by running sutures. No blood transfusion was need intraoperatively. There was no conversion to open approach.
Postoperative complications occurred in 2 (5%) patients with internal hemorrhage and were treated by laparoscopic exploration and bleeding control. Median hospital stay was 3 days without inpatient mortality. No hospital re-admission was reported in the early post-operative period.
There was significant decrease in mean BW at 18 months after surgery in relation to preoperative values (147.15 vs 84.47 kg, p= > 0.001). The maximum rate of decrease of mean BMI was at the first 6 months after surgery (52.5 vs 44.5 kg/m2) and gradually decreasing until reach 30.5 kg/m2 at 24 months. The EBWL at 3, 6, 12, 18, and 24 months were 15.32, 25.96, 36.21, 39.82, and 40.84 kg respectively. All patients had achieved %EBWL <50% at 12 months.
Seventeen patients (42.5%) had preoperative dyslipidemia (6 patients with high cholesterol and 11 with high triglyceride). The serum cholesterol and TGS reached normal values postoperatively at 18 and 24 months respectively. No nutritional deficiency was encountered in the study period during the follow up period. All obesity related co-morbidities have been resolved
Conclusion:
Weight loss surgery among adolescents, however, remains far less studied and utilized. Given the inadequate results of non-surgical weight management in adolescents, weight loss surgery has become a more appealing option. Laparoscopic sleeve gastrectomy has been approved as an efficient surgical management of adolescent obesity.
Obese adolescent will grow in the future to obese adult with increasing burden on health care systems. Many contributing factors result in obesity such as individual, dietary, social, behavioral, and environmental factors.
Multidisciplinary approaches were introduced in the previous studies for management of adolescent obesity. Non-surgical weight loss strategies like life-style modifications, physical exercise and dietary control have been crucial in obesity management; however, they have disappointing results. Pharmacological therapy has limited effect on weight control and long-term data is scarce. Consequently, growing interest emerged on the surface to obesity surgery for adolescent. Weight loss surgery remains the main stay and effective treatment for obesity and can result in loss 58% to 73% of excess body weight. Its efficacy had been proven for long-term weight control and control or even eliminating the obesity-related co-morbidities in adults.
The adolescent bariatric surgery gained popularity in the last decade with increasing number of cases worldwide. Promising results from previous studies showed major improvement in co-morbidities, psychological issues, and obesity-related mortality after surgery. On the other hand, there are many concerns regarding the ethical considerations, and surgery-related complications. More-over, long-term data after surgery including quality of life, pathological eating behavior and weight regain is rare in the literature.
Different surgical techniques such as sleeve gastrectomy, gastric banding, and Roux-en-Y gastric bypass had been evaluated regarding efficacy, safety and feasibility showing controversial results between different centers. High quality evidence such as randomized control studies, systematic reviews and meta-analysis regarding the safety of adolescent bariatric surgery is still deficient in the literature. And so, we conducted this study to assess the feasibility, safety, and short and long-term effects of laparoscopic sleeve gastrectomy for treatment of adolescent obesity.
Patient and methods:
This was retrospective study to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in obese adolescents. This study was carried out in Gastrointestinal Surgical Center, Mansoura University, Egypt. The patients’ data was collected from the prospectively maintained database in our center between 2014 to 2019.
Inclusion criteria
All adolescents aged from 12 to 20 years with body mass index (BMI) more than 40 kg/m2 or BMI higher 35 kg/m2 associated with obesity-related comorbidities were included in the study. The co-morbidities should be documented by the treating pediatrician or specialized referring physician. All eligible adolescents underwent non-surgical weight loss management such as lifestyle modifications, physical exercise, and dietary control but with unsatisfactory results within a minimum period of 12 months. Awareness of the adolescent and his or her family about the possible perioperative complications and the adherence to strict follow up program and dietary regimens.
Exclusion criteria included: eating disorders, lack of social family support, developmental immaturity, severe and uncontrolled cardiorespiratory disease, syndromes causing obesity (Prader Willi syndrome), and endocrinal disorders affecting the weight loss such as untreated hypothyroidism and prolactinoma. Patients with history of upper GI surgery were also excluded.
All patients underwent comprehensive evaluation by specialized team consisting of pediatrician, dietitian, bariatric surgeon, and psychologist before operation. Routine laboratory investigations and abdominal ultrasonography were routinely done. Upper GI endoscopy was done for patients complaining of GERD symptoms.
Standard 5-port LSG was done over size 40 fr bougie starting 4 cm proximal to pylorus was done using EndoGIA stapler (Johnson and Johnson or Covidien).
Follow up visits were scheduled at the outpatient clinic 2 and 4 weeks after surgery then 3, 6, 12, 18, and 24 months, then yearly. All patients were evaluated for excess weight loss, dysphagia, vomiting, eating behavior, comorbidity improvement, and any other complications.
Results:
Forty patients were included in the study; 18 male (45%) and 22 female (55%) with median age was 17 years (range, 14 – 20). Mean preoperative body weight (BW) and BMI were 147.15 ± 36.31 kg and 52.55 ± 11.61 kg/m2 respectively. All patients had at least one co-morbidity. Osteoarthritis was the most common obesity-related co-morbidity in the study cohort (14 patients, 35%). Four patients presented with GERD symptoms, of which 2 patients underwent upper GI endoscopy before surgery to confirm diagnosis. No syndromic obesity was identified in the study cohort.
Mean operative time was 119.25 min. Reinforcement of staple line was indicated in four cases. Intraoperative complications encountered during surgery were 2 patients with staple line bleeding controlled by clipping of the bleeding vessels and 2 stapling failure managed by running sutures. No blood transfusion was need intraoperatively. There was no conversion to open approach.
Postoperative complications occurred in 2 (5%) patients with internal hemorrhage and were treated by laparoscopic exploration and bleeding control. Median hospital stay was 3 days without inpatient mortality. No hospital re-admission was reported in the early post-operative period.
There was significant decrease in mean BW at 18 months after surgery in relation to preoperative values (147.15 vs 84.47 kg, p= > 0.001). The maximum rate of decrease of mean BMI was at the first 6 months after surgery (52.5 vs 44.5 kg/m2) and gradually decreasing until reach 30.5 kg/m2 at 24 months. The EBWL at 3, 6, 12, 18, and 24 months were 15.32, 25.96, 36.21, 39.82, and 40.84 kg respectively. All patients had achieved %EBWL <50% at 12 months.
Seventeen patients (42.5%) had preoperative dyslipidemia (6 patients with high cholesterol and 11 with high triglyceride). The serum cholesterol and TGS reached normal values postoperatively at 18 and 24 months respectively. No nutritional deficiency was encountered in the study period during the follow up period. All obesity related co-morbidities have been resolved
Conclusion:
Weight loss surgery among adolescents, however, remains far less studied and utilized. Given the inadequate results of non-surgical weight management in adolescents, weight loss surgery has become a more appealing option. Laparoscopic sleeve gastrectomy has been approved as an efficient surgical management of adolescent obesity.
Introduction:
Obese adolescent will grow in the future to obese adult with increasing burden on health care systems. Many contributing factors result in obesity such as individual, dietary, social, behavioral, and environmental factors.
Multidisciplinary approaches were introduced in the previous studies for management of adolescent obesity. Non-surgical weight loss strategies like life-style modifications, physical exercise and dietary control have been crucial in obesity management; however, they have disappointing results. Pharmacological therapy has limited effect on weight control and long-term data is scarce. Consequently, growing interest emerged on the surface to obesity surgery for adolescent. Weight loss surgery remains the main stay and effective treatment for obesity and can result in loss 58% to 73% of excess body weight. Its efficacy had been proven for long-term weight control and control or even eliminating the obesity-related co-morbidities in adults.
The adolescent bariatric surgery gained popularity in the last decade with increasing number of cases worldwide. Promising results from previous studies showed major improvement in co-morbidities, psychological issues, and obesity-related mortality after surgery. On the other hand, there are many concerns regarding the ethical considerations, and surgery-related complications. More-over, long-term data after surgery including quality of life, pathological eating behavior and weight regain is rare in the literature.
Different surgical techniques such as sleeve gastrectomy, gastric banding, and Roux-en-Y gastric bypass had been evaluated regarding efficacy, safety and feasibility showing controversial results between different centers. High quality evidence such as randomized control studies, systematic reviews and meta-analysis regarding the safety of adolescent bariatric surgery is still deficient in the literature. And so, we conducted this study to assess the feasibility, safety, and short and long-term effects of laparoscopic sleeve gastrectomy for treatment of adolescent obesity.
Patient and methods:
This was retrospective study to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in obese adolescents. This study was carried out in Gastrointestinal Surgical Center, Mansoura University, Egypt. The patients’ data was collected from the prospectively maintained database in our center between 2014 to 2019.
Inclusion criteria
All adolescents aged from 12 to 20 years with body mass index (BMI) more than 40 kg/m2 or BMI higher 35 kg/m2 associated with obesity-related comorbidities were included in the study. The co-morbidities should be documented by the treating pediatrician or specialized referring physician. All eligible adolescents underwent non-surgical weight loss management such as lifestyle modifications, physical exercise, and dietary control but with unsatisfactory results within a minimum period of 12 months. Awareness of the adolescent and his or her family about the possible perioperative complications and the adherence to strict follow up program and dietary regimens.
Exclusion criteria included: eating disorders, lack of social family support, developmental immaturity, severe and uncontrolled cardiorespiratory disease, syndromes causing obesity (Prader Willi syndrome), and endocrinal disorders affecting the weight loss such as untreated hypothyroidism and prolactinoma. Patients with history of upper GI surgery were also excluded.
All patients underwent comprehensive evaluation by specialized team consisting of pediatrician, dietitian, bariatric surgeon, and psychologist before operation. Routine laboratory investigations and abdominal ultrasonography were routinely done. Upper GI endoscopy was done for patients complaining of GERD symptoms.
Standard 5-port LSG was done over size 40 fr bougie starting 4 cm proximal to pylorus was done using EndoGIA stapler (Johnson and Johnson or Covidien).
Follow up visits were scheduled at the outpatient clinic 2 and 4 weeks after surgery then 3, 6, 12, 18, and 24 months, then yearly. All patients were evaluated for excess weight loss, dysphagia, vomiting, eating behavior, comorbidity improvement, and any other complications.
Results:
Forty patients were included in the study; 18 male (45%) and 22 female (55%) with median age was 17 years (range, 14 – 20). Mean preoperative body weight (BW) and BMI were 147.15 ± 36.31 kg and 52.55 ± 11.61 kg/m2 respectively. All patients had at least one co-morbidity. Osteoarthritis was the most common obesity-related co-morbidity in the study cohort (14 patients, 35%). Four patients presented with GERD symptoms, of which 2 patients underwent upper GI endoscopy before surgery to confirm diagnosis. No syndromic obesity was identified in the study cohort.
Mean operative time was 119.25 min. Reinforcement of staple line was indicated in four cases. Intraoperative complications encountered during surgery were 2 patients with staple line bleeding controlled by clipping of the bleeding vessels and 2 stapling failure managed by running sutures. No blood transfusion was need intraoperatively. There was no conversion to open approach.
Postoperative complications occurred in 2 (5%) patients with internal hemorrhage and were treated by laparoscopic exploration and bleeding control. Median hospital stay was 3 days without inpatient mortality. No hospital re-admission was reported in the early post-operative period.
There was significant decrease in mean BW at 18 months after surgery in relation to preoperative values (147.15 vs 84.47 kg, p= > 0.001). The maximum rate of decrease of mean BMI was at the first 6 months after surgery (52.5 vs 44.5 kg/m2) and gradually decreasing until reach 30.5 kg/m2 at 24 months. The EBWL at 3, 6, 12, 18, and 24 months were 15.32, 25.96, 36.21, 39.82, and 40.84 kg respectively. All patients had achieved %EBWL <50% at 12 months.
Seventeen patients (42.5%) had preoperative dyslipidemia (6 patients with high cholesterol and 11 with high triglyceride). The serum cholesterol and TGS reached normal values postoperatively at 18 and 24 months respectively. No nutritional deficiency was encountered in the study period during the follow up period. All obesity related co-morbidities have been resolved
Conclusion:
Weight loss surgery among adolescents, however, remains far less studied and utilized. Given the inadequate results of non-surgical weight management in adolescents, weight loss surgery has become a more appealing option. Laparoscopic sleeve gastrectomy has been approved as an efficient surgical management of adolescent obesity.
Obese adolescent will grow in the future to obese adult with increasing burden on health care systems. Many contributing factors result in obesity such as individual, dietary, social, behavioral, and environmental factors.
Multidisciplinary approaches were introduced in the previous studies for management of adolescent obesity. Non-surgical weight loss strategies like life-style modifications, physical exercise and dietary control have been crucial in obesity management; however, they have disappointing results. Pharmacological therapy has limited effect on weight control and long-term data is scarce. Consequently, growing interest emerged on the surface to obesity surgery for adolescent. Weight loss surgery remains the main stay and effective treatment for obesity and can result in loss 58% to 73% of excess body weight. Its efficacy had been proven for long-term weight control and control or even eliminating the obesity-related co-morbidities in adults.
The adolescent bariatric surgery gained popularity in the last decade with increasing number of cases worldwide. Promising results from previous studies showed major improvement in co-morbidities, psychological issues, and obesity-related mortality after surgery. On the other hand, there are many concerns regarding the ethical considerations, and surgery-related complications. More-over, long-term data after surgery including quality of life, pathological eating behavior and weight regain is rare in the literature.
Different surgical techniques such as sleeve gastrectomy, gastric banding, and Roux-en-Y gastric bypass had been evaluated regarding efficacy, safety and feasibility showing controversial results between different centers. High quality evidence such as randomized control studies, systematic reviews and meta-analysis regarding the safety of adolescent bariatric surgery is still deficient in the literature. And so, we conducted this study to assess the feasibility, safety, and short and long-term effects of laparoscopic sleeve gastrectomy for treatment of adolescent obesity.
Patient and methods:
This was retrospective study to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in obese adolescents. This study was carried out in Gastrointestinal Surgical Center, Mansoura University, Egypt. The patients’ data was collected from the prospectively maintained database in our center between 2014 to 2019.
Inclusion criteria
All adolescents aged from 12 to 20 years with body mass index (BMI) more than 40 kg/m2 or BMI higher 35 kg/m2 associated with obesity-related comorbidities were included in the study. The co-morbidities should be documented by the treating pediatrician or specialized referring physician. All eligible adolescents underwent non-surgical weight loss management such as lifestyle modifications, physical exercise, and dietary control but with unsatisfactory results within a minimum period of 12 months. Awareness of the adolescent and his or her family about the possible perioperative complications and the adherence to strict follow up program and dietary regimens.
Exclusion criteria included: eating disorders, lack of social family support, developmental immaturity, severe and uncontrolled cardiorespiratory disease, syndromes causing obesity (Prader Willi syndrome), and endocrinal disorders affecting the weight loss such as untreated hypothyroidism and prolactinoma. Patients with history of upper GI surgery were also excluded.
All patients underwent comprehensive evaluation by specialized team consisting of pediatrician, dietitian, bariatric surgeon, and psychologist before operation. Routine laboratory investigations and abdominal ultrasonography were routinely done. Upper GI endoscopy was done for patients complaining of GERD symptoms.
Standard 5-port LSG was done over size 40 fr bougie starting 4 cm proximal to pylorus was done using EndoGIA stapler (Johnson and Johnson or Covidien).
Follow up visits were scheduled at the outpatient clinic 2 and 4 weeks after surgery then 3, 6, 12, 18, and 24 months, then yearly. All patients were evaluated for excess weight loss, dysphagia, vomiting, eating behavior, comorbidity improvement, and any other complications.
Results:
Forty patients were included in the study; 18 male (45%) and 22 female (55%) with median age was 17 years (range, 14 – 20). Mean preoperative body weight (BW) and BMI were 147.15 ± 36.31 kg and 52.55 ± 11.61 kg/m2 respectively. All patients had at least one co-morbidity. Osteoarthritis was the most common obesity-related co-morbidity in the study cohort (14 patients, 35%). Four patients presented with GERD symptoms, of which 2 patients underwent upper GI endoscopy before surgery to confirm diagnosis. No syndromic obesity was identified in the study cohort.
Mean operative time was 119.25 min. Reinforcement of staple line was indicated in four cases. Intraoperative complications encountered during surgery were 2 patients with staple line bleeding controlled by clipping of the bleeding vessels and 2 stapling failure managed by running sutures. No blood transfusion was need intraoperatively. There was no conversion to open approach.
Postoperative complications occurred in 2 (5%) patients with internal hemorrhage and were treated by laparoscopic exploration and bleeding control. Median hospital stay was 3 days without inpatient mortality. No hospital re-admission was reported in the early post-operative period.
There was significant decrease in mean BW at 18 months after surgery in relation to preoperative values (147.15 vs 84.47 kg, p= > 0.001). The maximum rate of decrease of mean BMI was at the first 6 months after surgery (52.5 vs 44.5 kg/m2) and gradually decreasing until reach 30.5 kg/m2 at 24 months. The EBWL at 3, 6, 12, 18, and 24 months were 15.32, 25.96, 36.21, 39.82, and 40.84 kg respectively. All patients had achieved %EBWL <50% at 12 months.
Seventeen patients (42.5%) had preoperative dyslipidemia (6 patients with high cholesterol and 11 with high triglyceride). The serum cholesterol and TGS reached normal values postoperatively at 18 and 24 months respectively. No nutritional deficiency was encountered in the study period during the follow up period. All obesity related co-morbidities have been resolved
Conclusion:
Weight loss surgery among adolescents, however, remains far less studied and utilized. Given the inadequate results of non-surgical weight management in adolescents, weight loss surgery has become a more appealing option. Laparoscopic sleeve gastrectomy has been approved as an efficient surgical management of adolescent obesity.
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