Bariatric Surgery: Adolescents and Perioperative Course

Thomas H. Inge, M.D., Ph.D. Professor of Surgery and Pediatrics Director of the Surgical Weight Loss Program for Teens Director for the Center for Bariatric Research and Innovation Cincinnati Children’s Hospital Medical CenterMedicalResearch.com Interview with:
Thomas H. Inge, MD, PhD, FACS, FAAP
Surgical Director, Surgical Weight Loss Program for Teens
Director, Center for Bariatric Research and Innovation
Attending Surgeon, Cincinnati Children’s Hospital Medical Center
Professor, UC Department of Surgery
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

MedicalResearch.com: What are the main findings of the study?

Dr. Inge: The mean age of the 242 participants of this observational study was 17.1±1.6 years and the median BMI was 50.5 kg/m2.  Fifty-one percent demonstrated four or more major co-morbid conditions.  Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of subjects, respectively.  There were no deaths during the initial hospitalization or within 30 days of surgery; major complications were seen in 19 subjects (8%). Minor complications were noted in 36 subjects (15%).  All re-operations and 85% of re-admissions were related to WLS.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Inge: These adolescents are presenting for treatment with multiple comorbidities, which were previously not seen until adulthood.  Over 1/3 of participants (39%) presented with 4 or 5, and 12% presented with 6 or more co-morbid conditions. The most commonly observed comorbidities were dyslipidemia (74%), sleep apnea (57%), back and joint pain (46%), hypertension (45%), and fatty liver disease (37%).

The types of complications observed in our adolescents are similar to that which would be expected for WLS in severely obese adults.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Inge: The fact that major, life-threatening complications were infrequently observed documents the short-term safety of these procedures in this patient population.

Dr. Thomas Inge, surgeon at Cincinnati Children’s Hospital Medical Center and principal investigator of the Teen-LABS study, believes these findings should reassure parents who are considering bariatric surgery as a treatment option for their children:

“This is important news for families considering bariatric surgery for severely obese teens.
Parents who are considering weight loss surgery for their sons and daughters worry about complications and ask a lot about the safety of surgery. This study should help to alleviate or at least bring those concerns into context.”

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Inge: Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery.  Clinical data and saved biospecimens from this cohort will provide materials for more in-depth ancillary studies of obesity-related disease and response to surgical therapy in adolescents.  Longitudinal data from this cohort will inform us about the effects of surgery on co-morbidities, physical/metabolic health and health-related quality of life changes, nutritional effects, and durability of weight loss.

Psychosocial health of the adolescent patient is also an important consideration, which the Teen-LABS consortium is also addressing in a separate publication.

Citation:

Inge TH, Zeller MH, Jenkins TM, et al. Perioperative Outcomes of Adolescents Undergoing Bariatric Surgery: The Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA Pediatr. 2013;():-. doi:10.1001/jamapediatrics.2013.4296.

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