Laparoscopic sleeve gastrectomy safe, effective for obese adolescents
A Singapore study has shown that laparoscopic sleeve gastrectomy (LSG) is safe for morbidly obese adolescents, leading to good short-term weight loss outcomes and remission of several metabolic comorbid conditions.
“Our preliminary data showed that bariatric surgical intervention is a safe option for weight loss for obese adolescents in Singapore, with some resolution of associated comorbidities at 1 year after LSG,” researchers said.
Of the 208 LSGs analysed in the study, 13 (6.3 percent) were performed on obese adolescents (mean age 19.1 years; mean body mass index [BMI], 46.2 kg/m2). A family history of obesity (n=7) was often present. Also, common dietary habits included high-calorie drinks and food (n=12).
Comorbidities (n=12), such as hypertension (n=5), asthma (n=4), diabetes mellitus (n=3), hernia (n=3) and obstructive sleep apnoea requiring continuous positive airway pressure support (n=3), were common in most patients.
There was a 64.3-percent (range, 21.8–101.5 percent) excess weight loss at 1 year, while BMI and fat mass decreased to 31.2 (range, 23–40) kg/m2 and 17.4 kg, respectively. At 24 hours after surgery, pain score was 2/10. There was a mean 2.7 days of postoperative stay. No readmissions or complications were recorded. [Singapore Med J 2018;59:98-103]
Within 1 year of surgery, remission of diabetes and hypertension was reported in two of three and four of five adolescents, respectively.
“Long-term outcomes of sleeve gastrectomy in adults indicate that, on average, more than 60-percent excess BMI loss is maintained at over 10 years from surgery, even as de novo gastro-oesophageal reflux occurred in 8 percent of patients in Europe. Similar findings have been reported at five years in Asia,” researchers said. [Surg Obes Relat Dis 2016;12:1778-1786; Asian J Surg 2016;39:21-28]
“These recent findings, published after the completion of our study, attest to the durability of the procedure in adults. While our cohort showed excellent excess and absolute weight loss, and improvement in BMI at 12 and 18 months, the results at 3 years were not as good,” they noted.
Morbidly obese adolescents in the present study achieved effective weight loss after LSG, including effective resolution of comorbidities, according to researchers, suggesting early postoperative weight-bearing exercise to prevent muscle loss in this population.
“If lifestyle modifications fail after surgery, those adolescents would gain weight despite the metabolic modification effects of surgery,” researchers said. “The durability and efficacy of this surgery in young adults are partly dependent on the motivation of patients to adhere to the postoperative dietary and lifestyle regimens that are necessary to maintain the success of the weight loss procedure.”
Furthermore, obese adolescents are at risk of certain mental or behavioural disorders. In this cohort, 66.7 percent had depressive disorder symptoms, and this number was at the higher end of the 15–70-percent range found in the literature. For anxiety and eating disorder symptoms, the reported ranges prior to surgery were 15–33 percent and 48–70 percent, respectively. However, these symptoms significantly improved postsurgery. [Obes Facts 2014;7:233-245]
In this study, researchers retrospectively reviewed data of patients aged 16–19 years who underwent LSG and collected a lifestyle questionnaire, Berlin and Epworth scores, and Patient Health Questionnaire-9 scores. Finally, they recorded preoperative anthropometrics, comorbidities, weight loss and body composition outcomes.