Figure 1
Figure 2
Figure 3
up LRYGB is the most well studied procedure in adolescents with the best outcomes regarding weight-loss and resolution of comorbidities. Adolescents should expect to lose approximately 50 to 85% of their excess body weight with nearly complete resolution of obesity related co morbidities. Sustained weight loss with proven resolution of co- morbidities really is the greatest benefit of LRYGB. LRYGB also has the greatest potential for complications in adolescents, including mortality of approximately 0.5%. Risks specific to LRYBG include anastomotic leakage, small bowel obstruction, dumping syndrome (symptoms that may include nausea, bloating, vomiting, cramps, diarrhoea), protein-calorie malnutrition and micronutrient deficiency. Although these risks can be limited with a vitamin supplement regimen (iron, folate, vitamin B12, and thiamine) close follow-up essentially forever is crucial.
Adjustable Gastric Banding Adjustable gastric banding (LAGB) performed laparoscopically also provides significant weight reduction and resolution of co-morbidities, though typically at a much slower rate. Unlike LRYGB, LAGB is purely a restrictive procedure (see figure 2). LAGB involves placing a silicone band with an inflatable and adjustable inner tube around the upper stomach. This creates a very small pouch, restricts the passage of food, and delays the emptying of food into the stomach creating the feeling of satiety; the band can be inflated or deflated over time. Benefits of LAGB include the potential reversibility of the band, meaning the band can be removed and the anatomy is minimally unaltered. Currently, the U.S. Food and Drug Administration approve none of the available gastric bands for patients less than 18 years old. Complications related to LAGB can include port problems, infection, band slippage, intolerance, erosion of the band into the stomach with subsequent infection, spontaneous deflation of the band, and enlargement of the stomach pouch. Follow-up is important with any patient with a band as appropriate adjustments to the band are needed to ensure the band is not too tight causing obstruction or too loose. Therefore families who cannot reliably bring adolescents to clinic regularly (once a month) are poor candidates for LAGB. Families should be aware that the re-intervention rate with LAGB is quite high (more than 50%) over a long period of time. LAGB is one of the few procedures where randomized controlled data exists. A study comparing LAGB versus a supervised lifestyle intervention with a two-year follow-up was performed. The LAGB group lost 79% of their excess weight and showed a significant improvement of the metabolic syndrome, which was reduced from
022 ARAB HEALTH MAGAZINE ISSUE 2 2012
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