Adolescent Bariatric Surgery- Safety and Efficacy
Allison Leung MD (UNC Med/Peds Resident, PGY 4) reviewing Lennerz BS, et al. Bariatric surgery in
adolescents and young adults--safety and effectiveness in a cohort of 345 patients. International Journal
of Obesity (London) Sep 2013
Although bariatric surgery has been shown to be effective for adults, evidence is still lacking for safety
and long term efficacy for adolescents. In adult studies bariatric surgery may be the most effective
treatment available for obesity and obesity related illnesses. Furthermore, complications tend to be rare.
However, there are limited studies in adolescents. To address this issue investigator did a prospective,
multicenter observational study in Germany. They had 345 participants age 8-21 entered into an online
registry. The primary endpoint is reduction in BMI and obesity related comorbidity after bariatric surgery
(including gastric bypass, sleeve gastrectomy, and gastric banding).
The majority of participants were over the age of 18 (85%). Participant were followed for up to over 30
months. However, only data was available for 48% at follow up and only 10% of participants followed up
more than once. With the data available, investigators concluded there was a significant BMI reduction.
BMI decrease by mean of 12.7 ± 8.2 (CI of -14 to -11.5 and P <.001). The BMI reduction seems sustained
after 2 years. Of the obesity related illnesses, only hypertension was significantly reduced. Hypertension
rate decreased from 32.9% of the participations to 16.8% after surgery. There was no morality but postoperative complications were as high as 9.1% in sleeve gastrectomy including sepsis and abdominal
abscess.
Clinical Bottom Line: Although the study concludes that bariatric surgery is effective with low, short term
complications; the study design has significant limitations. It is difficult to conclude efficacy without
comparing to the standard of care lifestyle modification. Furthermore, significant amount of patients were
lost to follow-up. Although complication rate were low and short term, the study did not address
psychological impact of surgery which may be significant for adolescents compared to adults. The study
does demonstrate reduction in BMI but lacks sufficient evidence that is better than lifestyle modifications
ad long term safety in adolescents.