by Dr. Enozia Vakil on  January 10, 2013 at 11:41 AM Health In Focus
Gastric Bypass Surgery in Adolescents With Severe Obesity
In the age of technology and development, the national boundaries have blurred and the horizons have widened, bringing us closer to a whole new world of amazing gadgets and medical innovations. Healthcare and medicine have made equal progress and have resulted in the development of amazing new drugs, surgical procedures and clinical trials.

The gastric bypass surgery for adolescents is one such amazing development aiming to reduce morbid obesity among adolescents. The introduction of this surgical procedure may give rise to a whole new treatment method, which in the future may help millions treat obesity and related issues. Let us have a closer look at the how's and what's of this surgical procedure.

Previous surgical procedures: While obesity treatments for children and adolescents lie solely on behavioral and non-surgical therapies, adults suffering from obesity can benefit by turning to bariatric surgery. It is a surgical procedure that reduces mortality rates, induces long-term weight loss and improves overall quality of life. Due to lack of effective treatment for obesity among children, an increase in psychosocial problems, mental illnesses, cancer, cardiovascular ailments and metabolic and endocrine disorders have been noted.

The bariatric surgery was not formerly allowed to be carried out in individuals less than 18 years of age. However, a recent well-designed trial may prove to be the emergence of a whole new concept in obesity treatment among teens. The trial conducted by Torsten Olbers and his colleagues and published in the International Journal of Obesity involved the randomization of gastric bypass surgery with normal lifestyle intervention to demonstrate the efficacy of the surgery over the convention treatment.

Eligibility criteria: Eighty oneadolescents, selected from the Swedish Childhood Obesity Treatment Register (BORIS) and in the age range of 13 to 18 years, were admitted as subjects for this Swedish trial and were made to undergo conservative treatments including family and/or personal counseling, cognitive behavioral therapy and dietary changes. Low calorie diets and drugs like metformin and sibutramin were prescribed regularly. After 1 year of following this comprehensive treatment, the subjects were made to undergo gastric bypass surgery as a part of the clinical trial.

The trial: For the laparoscopic Roux-en-Y gastric bypass surgery, the subjects were made to follow a low calorie diet for at least 3 weeks before the surgery, after which they were operated upon by experienced surgeons. Proper post-operative care was given.

Health risks: Among the 12 subjects that required additional surgical interventions, 5 patients needed to undergo an operation for internal hernia, five required cholecystectomy and four were made to rush to the emergency room due to non-specific abdominal pain. Persistent anxiety and depression, self-harm behavior, unplanned pregnancies and suicide attempts were also observed after the surgery.

Follow-up: As a follow-up, the surgical patients were assessed 1 month prior to the surgery, and 2, 3,6,12 and 24 months post surgery. Body weight, height, biochemical analysis and blood pressure were kept under check. Multivitamin and mineral supplements were added to their daily diets. Regular visits to health centers and pediatricians were carried out as part of the trial.

Comparison to conventional treatments: Where conventional treatments for obesity in adolescents demonstrated poor outcomes, gastric bypass surgery showed a substantial weight decrease of 32 percent over two years following the surgery.

The verdict: While the surgery did show prevalence of psychosocial problems and mental illnesses, obese adolescents free from these mental illnesses may actually benefit a lot by undergoing this surgery compared to the conventional treatment.

Reference: Olbers T., et al. Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS). International Journal of Obesity advance online publication, September 25 2012. doi:10.1038/ijo.2012.160

Source: Medindia

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