Skip to main content
SpringerLink
Log in

Long-term results after laparoscopic adjustable gastric banding in adolescent patients: follow-up of the Austrian experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

During the last 30 years a threefold increase in the number of overweight children has been reported in Western countries. More than 15% of adolescents have a body mass index (BMI) higher than the 95th percentile. The use of surgical strategies in adolescent patients is still controversial due to the impact on the continuing maturing process. Laparoscopic adjustable gastric banding (LAGB) is considered a minimal invasive procedure that does not alter the physiological behavior of the bowel and has already shown promising results in short-term studies.

Methods

Between 1998 and 2004, 50 adolescent patients above the 99.5th age- and gender-adjusted growing percentile were treated with LAGB. The surgical procedure was performed at three highly experienced centers for bariatric surgery. Mean age was 17.1 ± 2.2 years (range = 9–19 years) at the time of surgery. Follow-up investigations were performed in the outpatient clinic of the treating hospitals. Psychological changes were analyzed using the BAROS questionnaire.

Results

The mean BMI decreased from 45.2 ± 7.6 kg/m2 at the time of surgery to 38.3 ± 6.2 kg/m2 1 year after surgery, 31.5 ± 6.6 kg/m2 after 3 years, and 27.3 ± 5.3 kg/m2 after 5 years. Mean excessive weight loss was 49.7 ± 29.2, 76.8 ± 27.5, and 92.6 ± 24.5% at 1, 3, and 5 years after surgery. Quality of life showed a further significant improvement between 3 and 5 years after surgery (BAROS: 5.5 ± 1.9 increased to 6.3 ± 2.2, p = 0.01). All preoperative comorbidities resolved in patients with a functional band after 5 years of follow-up.

Conclusion

LAGB shows promising results in the long-term follow-up with continuous weight loss in patients with a functional band. Nevertheless, most of the weight loss is within the first 3 years after surgery. Thereafter, further weight reduction is about 10% over the following 2 years. Perioperative comorbidities resolve within the first 5 years after treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dietz WH, Robinson TN (2005) Clinical practice. Overweight children and adolescents. N Engl J Med 352:2100–2109

    Article  PubMed  CAS  Google Scholar 

  2. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:2847–2850

    Article  PubMed  CAS  Google Scholar 

  3. Hill JO, Trowbridge FL (1998) Childhood obesity: future directions and research priorities. Pediatrics 101:570–574

    Article  PubMed  CAS  Google Scholar 

  4. Must A, Strauss RS (1999) Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 23(Suppl 2):S2–S11

    Article  PubMed  Google Scholar 

  5. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350:2362–2374

    Article  PubMed  CAS  Google Scholar 

  6. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, Girardet JP, Bonnet D (2001) Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 358:1400–1404

    Article  PubMed  CAS  Google Scholar 

  7. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 338:1650–1656

    Article  PubMed  CAS  Google Scholar 

  8. Baker JL, Olsen LW, Sorensen TI (2007) Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 357:2329–2337

    Article  PubMed  CAS  Google Scholar 

  9. Schwimmer JB, Burwinkle TM, Varni JW (2003) Health-related quality of life of severely obese children and adolescents. JAMA 289:1813–1819

    Article  PubMed  Google Scholar 

  10. Abu-Abeid S, Gavert N, Klausner JM, Szold A (2003) Bariatric surgery in adolescence. J Pediatr Surg 38:1379–1382

    Article  PubMed  Google Scholar 

  11. Mossberg HO (1989) 40-year follow-up of overweight children. Lancet 2:491–493

    Article  PubMed  CAS  Google Scholar 

  12. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH (1997) Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 337:869–873

    Article  PubMed  CAS  Google Scholar 

  13. Dietz WH (1998) Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 101:518–525

    PubMed  CAS  Google Scholar 

  14. Levine MD, Ringham RM, Kalarchian MA, Wisniewski L, Marcus MD (2001) Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord 30:318–328

    Article  PubMed  CAS  Google Scholar 

  15. Yanovski JA (2001) Intensive therapies for pediatric obesity. Pediatr Clin North Am 48:1041–1053

    Article  PubMed  CAS  Google Scholar 

  16. Weigle DS, Brunzell JD (1990) Assessment of energy expenditure in ambulatory reduced-obese subjects by the techniques of weight stabilization and exogenous weight replacement. Int J Obes 14(Suppl 1):69–77 discussion 77–81

    PubMed  Google Scholar 

  17. Wood PD, Stefanick ML, Dreon DM, Frey-Hewitt B, Garay SC, Williams PT, Superko HR, Fortmann SP, Albers JJ, Vranizan KM et al (1988) Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med 319:1173–1179

    Article  PubMed  CAS  Google Scholar 

  18. Inge TH, Krebs NF, Garcia VF, Skelton JA, Guice KS, Strauss RS, Albanese CT, Brandt ML, Hammer LD, Harmon CM, Kane TD, Klish WJ, Oldham KT, Rudolph CD, Helmrath MA, Donovan E, Daniels SR (2004) Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics 114:217–223

    Article  PubMed  Google Scholar 

  19. Wichmann MW, Muller C, Lau-Werner U, Strauss T, Lang RA, Hornung HM, Stieber P, Schildberg FW (2000) The role of carcinoembryonic antigen for the detection of recurrent disease following curative resection of large-bowel cancer. Langenbecks Arch Surg 385:271–275

    Article  PubMed  CAS  Google Scholar 

  20. Inge TH, Xanthakos SA, Zeller MH (2007) Bariatric surgery for pediatric extreme obesity: now or later? Int J Obes (Lond) 31:1–14

    Article  CAS  Google Scholar 

  21. Nadler EP, Youn HA, Ginsburg HB, Ren CJ, Fielding GA (2007) Short-term results in 53 US obese pediatric patients treated with laparoscopic adjustable gastric banding. J Pediatr Surg 42:137–141 discussion 141–132

    Article  PubMed  Google Scholar 

  22. Al-Qahtani AR (2007) Laparoscopic adjustable gastric banding in adolescent: safety and efficacy. J Pediatr Surg 42:894–897

    Article  PubMed  Google Scholar 

  23. Parikh MS, Fielding GA, Ren CJ (2005) U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc 19:1631–1635

    Article  PubMed  CAS  Google Scholar 

  24. Hu H, Zhu J, Wang W, Huang A (2010) Optimized transumbilical endoscopic cholecystectomy: a randomized comparison of two procedures. Surg Endosc 24(5):1080–1084

    Article  PubMed  Google Scholar 

  25. Rodgers BM (2004) Bariatric surgery for adolescents: a view from the American Pediatric Surgical Association. Pediatrics 114:255–256

    Article  PubMed  Google Scholar 

  26. Towbin A, Inge TH, Garcia VF, Roehrig HR, Clements RH, Harmon CM, Daniels SR (2004) Beriberi after gastric bypass surgery in adolescence. J Pediatr 145:263–267

    Article  PubMed  Google Scholar 

  27. Silberhumer GR, Miller K, Kriwanek S, Widhalm K, Pump A, Prager G (2006) Laparoscopic adjustable gastric banding in adolescents: the Austrian experience. Obes Surg 16:1062–1067

    Article  PubMed  Google Scholar 

  28. Dolan K, Creighton L, Hopkins G, Fielding G (2003) Laparoscopic gastric banding in morbidly obese adolescents. Obes Surg 13:101–104

    Article  PubMed  Google Scholar 

  29. Fielding GA, Duncombe JE (2005) Laparoscopic adjustable gastric banding in severely obese adolescents. Surg Obes Relat Dis 1:399–405 discussion 405–397

    Article  PubMed  Google Scholar 

  30. Angrisani L, Favretti F, Furbetta F, Paganelli M, Basso N, Doldi SB, Iuppa A, Lucchese M, Lattuada E, Lesti G, Capizzi FD, Giardiello C, Di Lorenzo N, Veneziani A, Alkilani M, Puglisi F, Gardinazzi A, Cascardo A, Borrelli V, Lorenzo M (2005) Obese teenagers treated by Lap-Band System: the Italian experience. Surgery 138:877–881

    Article  PubMed  CAS  Google Scholar 

  31. Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K (2007) Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond) 31:569–577

    CAS  Google Scholar 

  32. Hell E, Miller KA, Moorehead MK, Norman S (2000) Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obes Surg 10:214–219

    Article  PubMed  CAS  Google Scholar 

  33. Moorehead MK, Ardelt-Gattinger E, Lechner H, Oria HE (2003) The validation of the Moorehead-Ardelt Quality of Life Questionnaire II. Obes Surg 13:684–692

    Article  PubMed  Google Scholar 

  34. Oria HE (2003) The BAROS and the Moorehead-Ardelt quality of life questionnaire. Obes Surg 13:965

    Article  PubMed  Google Scholar 

  35. Oria HE, Moorehead MK (1998) Bariatric analysis and reporting outcome system (BAROS). Obes Surg 8:487–499

    Article  PubMed  CAS  Google Scholar 

  36. Deitel M, Gawdat K, Melissas J (2007) Reporting weight loss 2007. Obes Surg 17:565–568

    Article  PubMed  Google Scholar 

  37. Dixon JB, McPhail T, O’Brien PE (2005) Minimal reporting requirements for weight loss: current methods not ideal. Obes Surg 15:1034–1039

    Article  PubMed  Google Scholar 

  38. Brolin RE, Kenler HA, Gorman RC, Cody RP (1989) The dilemma of outcome assessment after operations for morbid obesity. Surgery 105:337–346

    PubMed  CAS  Google Scholar 

  39. Finkelstein EA, Fiebelkorn IC, Wang G (2003) National medical spending attributable to overweight and obesity: how much, and who’s paying? Health Aff (Millwood) Suppl Web Exclusives:W3-219–226

  40. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS (2001) Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics 108:712–718

    Article  PubMed  CAS  Google Scholar 

  41. Parsons TJ, Power C, Logan S, Summerbell CD (1999) Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord 23(Suppl 8):S1–S107

    PubMed  Google Scholar 

  42. Guo SS, Huang C, Maynard LM, Demerath E, Towne B, Chumlea WC, Siervogel RM (2000) Body mass index during childhood, adolescence and young adulthood in relation to adult overweight and adiposity: the Fels Longitudinal Study. Int J Obes Relat Metab Disord 24:1628–1635

    Article  PubMed  CAS  Google Scholar 

  43. Capella JF, Capella RF (2003) Bariatric surgery in adolescence. is this the best age to operate? Obes Surg 13:826–832

    Article  PubMed  Google Scholar 

  44. Elder KA, Wolfe BM (2007) Bariatric surgery: a review of procedures and outcomes. Gastroenterology 132:2253–2271

    Article  PubMed  Google Scholar 

  45. Chapman AE, Kiroff G, Game P, Foster B, O’Brien P, Ham J, Maddern GJ (2004) Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 135:326–351

    Article  PubMed  Google Scholar 

  46. Parikh MS, Laker S, Weiner M, Hajiseyedjavadi O, Ren CJ (2006) Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg 202:252–261

    Article  PubMed  Google Scholar 

  47. Dillard BE 3rd, Gorodner V, Galvani C, Holterman M, Browne A, Gallo A, Horgan S, Le Holterman AX (2007) Initial experience with the adjustable gastric band in morbidly obese US adolescents and recommendations for further investigation. J Pediatr Gastroenterol Nutr 45:240–246

    Article  PubMed  Google Scholar 

  48. DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235:640–645 discussion 645–647

    Article  PubMed  Google Scholar 

  49. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529

    Article  PubMed  CAS  Google Scholar 

  50. O’Brien PE, McPhail T, Chaston TB, Dixon JB (2006) Systematic review of medium-term weight loss after bariatric operations. Obes Surg 16:1032–1040

    Article  PubMed  Google Scholar 

  51. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  52. Cottam DR, Atkinson J, Anderson A, Grace B, Fisher B (2006) A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg 16:534–540

    Article  PubMed  Google Scholar 

  53. Bowne WB, Julliard K, Castro AE, Shah P, Morgenthal CB, Ferzli GS (2006) Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg 141:683–689

    Article  PubMed  Google Scholar 

  54. Inge TH, Xanthakos S (2010) Sleeve gastrectomy for childhood morbid obesity: why not? Obes Surg 20:118–120

    Article  PubMed  Google Scholar 

  55. [No authors listed] (1992) Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 55(Suppl 2):615S–619S

    Google Scholar 

  56. Kuther T (2003) Medical decision-making and minors: issues of consent and assent. Adolescence 38:343–358

    PubMed  Google Scholar 

  57. Stanford A, Glascock JM, Eid GM, Kane T, Ford HR, Ikramuddin S, Schauer P (2003) Laparoscopic Roux-en-Y gastric bypass in morbidly obese adolescents. J Pediatr Surg 38:430–433

    Article  PubMed  Google Scholar 

  58. Dixon JB, O’Brien PE (2002) Changes in comorbidities and improvements in quality of life after LAP-BAND placement. Am J Surg 184:51S–54S

    Article  PubMed  Google Scholar 

  59. Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D (2003) Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238:467–484 discussion 484–465

    PubMed  Google Scholar 

  60. Garcia VF, DeMaria EJ (2006) Adolescent bariatric surgery: treatment delayed, treatment denied, a crisis invited. Obes Surg 16:1–4

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. Prager has an education grant from Covidien for 2009/2010. Drs. Silberhumer, Miller, Pump, Kriwanek, Widhalm, and Gyoeri have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Gerd R. Silberhumer, Georg Gyoeri & Gerhard Prager

  2. Department of Surgery, Hospital Hallein, Salzburg, Austria

    Karl Miller & Antonia Pump

  3. Department of Surgery, Hospital Rudolfstiftung, Vienna, Austria

    Stefan Kriwanek

  4. Department of Pediatrics, Medical University of Vienna, Vienna, Austria

    Kurt Widhalm

Authors
  1. Gerd R. Silberhumer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonia Pump
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Kriwanek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kurt Widhalm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Georg Gyoeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gerhard Prager
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerhard Prager.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Silberhumer, G.R., Miller, K., Pump, A. et al. Long-term results after laparoscopic adjustable gastric banding in adolescent patients: follow-up of the Austrian experience. Surg Endosc 25, 2993–2999 (2011). https://doi.org/10.1007/s00464-011-1658-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1658-5

Keywords

Search

Navigation