Gastric Bypass Surgery in Adolescents With Severe Obesity

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.

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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