Skip to main content
Top
Published in: Surgical Endoscopy 11/2012

01-11-2012

Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study

Authors: Aayed Alqahtani, Hussam Alamri, Mohamed Elahmedi, Rafiuddin Mohammed

Published in: Surgical Endoscopy | Issue 11/2012

Login to get access

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is a recent bariatric procedure that has gained widespread popularity in morbidly obese adults. However, pediatric bariatric surgery is controversial, and the type(s) of bariatric surgery that are suitable for children and adolescents is under debate. No studies exit that compare LSG outcomes in adult and pediatric patients. We reviewed our experience to assess the safety, efficacy, and complications of LSG in adult and pediatric morbidly obese patients.

Methods

A retrospective review of all patients who underwent LSG by a single surgeon between March 2008 and February 2011 was performed. The 222 patients included 108 pediatric patients aged 21 years or younger and 114 adult patients older than 21 years. Baseline, operative, perioperative, and available follow-up data were abstracted.

Results

Pediatric patients had a mean age of 13.9 ± 4.3 years and a mean baseline body mass index (BMI) of 49.6 kg/m2, whereas adults had a mean age of 32.2 ± 9.4 years and a mean baseline BMI of 48.3 kg/m2. Our pediatric group achieved a mean percent of excess weight loss (%EWL) of 32.4, 52.1, 65.8, and 64.9 % at 3, 6, 12, and 24 months postoperative, respectively, compared with a mean %EWL of 30.9, 55.2, 68.5, and 69.7 %, respectively, in our adult group (p > 0.05). During the 24-month follow-up period, pediatric patients attended 71.7 % of follow-up visits, whereas adults attended 61.2 % of follow-up visits (p = 0.01). Postoperative complications occurred in six (5.6 %) and eight (7 %) pediatric and adult patients, respectively.

Conclusions

Laparoscopic sleeve gastrectomy in the pediatric age group is of similar safety and effectiveness compared with adults. Pediatric patients had fewer major complications and were more compliant with follow-up than adults. Nevertheless, long-term results are required to further clarify the safety and effectiveness of LSG in pediatric patients.
Literature
1.
go back to reference Ogden CL et al (2012) Prevalence of obesity and trends in body mass index among U.S. children and adolescents, 1999–2010. JAMA 307(5):483–490PubMedCrossRef Ogden CL et al (2012) Prevalence of obesity and trends in body mass index among U.S. children and adolescents, 1999–2010. JAMA 307(5):483–490PubMedCrossRef
2.
go back to reference Reilly JJ, Kelly J (2011) Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (London) 35(7):891–898CrossRef Reilly JJ, Kelly J (2011) Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (London) 35(7):891–898CrossRef
3.
go back to reference Arens R, Muzumdar H (2010) Childhood obesity and obstructive sleep apnea syndrome. J Appl Physiol 108(2):436–444PubMedCrossRef Arens R, Muzumdar H (2010) Childhood obesity and obstructive sleep apnea syndrome. J Appl Physiol 108(2):436–444PubMedCrossRef
4.
go back to reference De Ferranti SD, Osganian SK (2007) Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus. Diab Vasc Dis Res 4(4):285–296PubMedCrossRef De Ferranti SD, Osganian SK (2007) Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus. Diab Vasc Dis Res 4(4):285–296PubMedCrossRef
5.
go back to reference Riley MR et al (2005) Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatric subspecialists. J Pediatr 147(6):839–842PubMedCrossRef Riley MR et al (2005) Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatric subspecialists. J Pediatr 147(6):839–842PubMedCrossRef
6.
go back to reference Pinhas-Hamiel O et al (1996) Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 128(5 Pt 1):608–615PubMed Pinhas-Hamiel O et al (1996) Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 128(5 Pt 1):608–615PubMed
7.
go back to reference Serdula MK et al (1993) Do obese children become obese adults? A review of the literature. Prev Med 22(2):167–177PubMedCrossRef Serdula MK et al (1993) Do obese children become obese adults? A review of the literature. Prev Med 22(2):167–177PubMedCrossRef
8.
go back to reference Schwimmer JB, Burwinkle TM, Varni JW (2003) Health-related quality of life of severely obese children and adolescents. JAMA 289(14):1813–1819PubMedCrossRef Schwimmer JB, Burwinkle TM, Varni JW (2003) Health-related quality of life of severely obese children and adolescents. JAMA 289(14):1813–1819PubMedCrossRef
9.
go back to reference Burke V et al (2004) Associations between blood pressure and overweight defined by new standards for body mass index in childhood. Prev Med 38(5):558–564PubMedCrossRef Burke V et al (2004) Associations between blood pressure and overweight defined by new standards for body mass index in childhood. Prev Med 38(5):558–564PubMedCrossRef
10.
go back to reference Berkowitz RI et al (2003) Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial. JAMA 289(14):1805–1812PubMedCrossRef Berkowitz RI et al (2003) Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial. JAMA 289(14):1805–1812PubMedCrossRef
11.
go back to reference Connelly JB, Duaso MJ, Butler G (2007) A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public Health 121(7):510–517PubMedCrossRef Connelly JB, Duaso MJ, Butler G (2007) A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public Health 121(7):510–517PubMedCrossRef
12.
go back to reference Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J (2005) Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA 293(23):2873–2883. Erratum: 294(12):1491 Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J (2005) Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA 293(23):2873–2883. Erratum: 294(12):1491
13.
go back to reference Savoye M et al (2007) Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA 297(24):2697–2704PubMedCrossRef Savoye M et al (2007) Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA 297(24):2697–2704PubMedCrossRef
14.
go back to reference Sjostrom L et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351(26):2683–2693PubMedCrossRef Sjostrom L et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351(26):2683–2693PubMedCrossRef
15.
go back to reference Tsai WS, Inge TH, Burd RS (2007) Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med 161(3):217–221PubMedCrossRef Tsai WS, Inge TH, Burd RS (2007) Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med 161(3):217–221PubMedCrossRef
16.
go back to reference Treadwell JR, Sun F, Schoelles K (2008) Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg 248(5):763–776PubMedCrossRef Treadwell JR, Sun F, Schoelles K (2008) Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg 248(5):763–776PubMedCrossRef
17.
go back to reference Shi X et al (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20(8):1171–1177PubMedCrossRef Shi X et al (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20(8):1171–1177PubMedCrossRef
18.
19.
20.
go back to reference Leon JM et al (2007) Obesity surgery in a 12-year-old: an Ecuadorian experience. Obes Surg 17(2):258–259PubMedCrossRef Leon JM et al (2007) Obesity surgery in a 12-year-old: an Ecuadorian experience. Obes Surg 17(2):258–259PubMedCrossRef
21.
go back to reference Dan D et al (2010) Bariatric surgery in the management of childhood obesity: should there be an age limit? Obes Surg 20(1):114–117PubMedCrossRef Dan D et al (2010) Bariatric surgery in the management of childhood obesity: should there be an age limit? Obes Surg 20(1):114–117PubMedCrossRef
22.
go back to reference Till HK et al (2008) Laparoscopic sleeve gastrectomy achieves substantial weight loss in an adolescent girl with morbid obesity. Eur J Pediatr Surg 18(1):47–49PubMedCrossRef Till HK et al (2008) Laparoscopic sleeve gastrectomy achieves substantial weight loss in an adolescent girl with morbid obesity. Eur J Pediatr Surg 18(1):47–49PubMedCrossRef
23.
go back to reference Till H et al (2008) Efficacy of laparoscopic sleeve gastrectomy (LSG) as a stand-alone technique for children with morbid obesity. Obes Surg 18(8):1047–1049PubMedCrossRef Till H et al (2008) Efficacy of laparoscopic sleeve gastrectomy (LSG) as a stand-alone technique for children with morbid obesity. Obes Surg 18(8):1047–1049PubMedCrossRef
24.
go back to reference Al-Qahtani A (2011) Surgical approaches to pediatric obesity. In: Ferry RJ Jr (ed) Management of pediatric obesity and diabetes, 1st edn. Springer, New York, pp 221–248CrossRef Al-Qahtani A (2011) Surgical approaches to pediatric obesity. In: Ferry RJ Jr (ed) Management of pediatric obesity and diabetes, 1st edn. Springer, New York, pp 221–248CrossRef
25.
go back to reference NIH Consensus Conference Statement (1992) Gastrointestinal Surgery for Severe Obesity. National Institutes of Health Consensus Development Conference Statement, March 25-27, 1991. Am J Clin Nutr 55(2):S615–S619 NIH Consensus Conference Statement (1992) Gastrointestinal Surgery for Severe Obesity. National Institutes of Health Consensus Development Conference Statement, March 25-27, 1991. Am J Clin Nutr 55(2):S615–S619
26.
go back to reference National Cholesterol Education Program (NCEP) (1992) Highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 89(3):495–501 National Cholesterol Education Program (NCEP) (1992) Highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 89(3):495–501
27.
go back to reference Chobanian AV et al (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report (vol 289, p 2560). JAMA 290(2):197 Chobanian AV et al (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report (vol 289, p 2560). JAMA 290(2):197
28.
go back to reference National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2):555–576 National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2):555–576
29.
go back to reference American Diabetes Association (2011) Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl 1):S62–S69CrossRef American Diabetes Association (2011) Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl 1):S62–S69CrossRef
30.
go back to reference Cleeman JI et al (2001) Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285(19):2486–2497CrossRef Cleeman JI et al (2001) Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285(19):2486–2497CrossRef
31.
go back to reference Anonymous (1983) 1983 metropolitan height and weight tables. Stat Bull Metrop Life Found 64(1):3–9 Anonymous (1983) 1983 metropolitan height and weight tables. Stat Bull Metrop Life Found 64(1):3–9
32.
go back to reference Kuczmarski RJ et al (2000) CDC growth charts: United States. Adv Data 314:1–27PubMed Kuczmarski RJ et al (2000) CDC growth charts: United States. Adv Data 314:1–27PubMed
33.
go back to reference Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5(4):469–475PubMedCrossRef Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5(4):469–475PubMedCrossRef
34.
go back to reference Lawson ML et al (2006) One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J Pediatr Surg 41(1):137–143PubMedCrossRef Lawson ML et al (2006) One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J Pediatr Surg 41(1):137–143PubMedCrossRef
35.
go back to reference O’Brien PE et al (2010) Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 303(6):519–526PubMedCrossRef O’Brien PE et al (2010) Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 303(6):519–526PubMedCrossRef
36.
go back to reference Al-Qahtani AR (2007) Laparoscopic adjustable gastric banding in adolescent: safety and efficacy. J Pediatr Surg 42(5):894–897PubMedCrossRef Al-Qahtani AR (2007) Laparoscopic adjustable gastric banding in adolescent: safety and efficacy. J Pediatr Surg 42(5):894–897PubMedCrossRef
37.
go back to reference Alqahtani A (2011) Robotic gastric banding in children and adolescents: a comparative study. Surg Endosc 25(11):3647–3651PubMedCrossRef Alqahtani A (2011) Robotic gastric banding in children and adolescents: a comparative study. Surg Endosc 25(11):3647–3651PubMedCrossRef
38.
39.
go back to reference Tice JA et al (2008) Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med 121(10):885–893PubMedCrossRef Tice JA et al (2008) Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med 121(10):885–893PubMedCrossRef
40.
go back to reference Varela JE, Hinojosa MW, Nguyen NT (2007) Perioperative outcomes of bariatric surgery in adolescents compared with adults at academic medical centers. Surg Obes Relat Dis 3(5):537–540PubMedCrossRef Varela JE, Hinojosa MW, Nguyen NT (2007) Perioperative outcomes of bariatric surgery in adolescents compared with adults at academic medical centers. Surg Obes Relat Dis 3(5):537–540PubMedCrossRef
41.
go back to reference Hutter MM et al (2011) First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 254(3):410–420PubMedCrossRef Hutter MM et al (2011) First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 254(3):410–420PubMedCrossRef
42.
go back to reference Toussi R, Fujioka K, Coleman KJ (2009) Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity (Silver Spring) 17(5):996–1002CrossRef Toussi R, Fujioka K, Coleman KJ (2009) Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity (Silver Spring) 17(5):996–1002CrossRef
Metadata
Title
Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study
Authors
Aayed Alqahtani
Hussam Alamri
Mohamed Elahmedi
Rafiuddin Mohammed
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 11/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2345-x

Other articles of this Issue 11/2012

Surgical Endoscopy 11/2012 Go to the issue