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.