FEATURE OBESITY 023
36% to zero. There was also an improved quality of life. However, 33% required revision procedures either for proximal pouch dilatation or tubing injury during follow-up. Long-term research will be important regarding LAGB as removal/reversal of a gastric banding may have a high rate of weight re-gain as noticed in adults. It is unknown how long an adolescent may tolerate a gastric band and the required follow-up.
Sleeve Gastrectomy Less is known about laparoscopic sleeve gastrectomy (LSG), yet LSG is emerging as a potential alternative bariatric procedure in well selected adolescents. During LSG, about 85% of the stomach is removed so that it takes the shape of a tube or sleeve (see figure 3). This resected portion of the stomach is removed and therefore LSG is essentially a restrictive, non- reversible procedure. Gastric sleeve dilatations and staple line leaks are the most common complications. There is limited short- and long-term data on outcomes in adolescents although new studies are due to be published within a few months documenting excellent results in adolescents with LSG (data reviewed by Dr. Zarroug). Long-term nutritional risks, sustained weight loss effectiveness, and durability of resolution of comorbidities in growing children must be adequately evaluated.
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of comorbidities similar to or slightly less than that of LRYGB with less significant malabsorption and no deaths. Other advantages are that LSG involves no foreign body (band) and needs no invasive adjustments.
FUTURE DIRECTIONS All of the adolescent bariatric procedures discussed must be performed in the background of positive behavioral modifications over a period of time. If lifestyle modification fails, these adolescents can gain weight by overcoming the physiologic effects of the procedure as they eat high calorie foods at very frequent intervals. Lastly, close postoperative follow- up is required with active management of weight changes, comorbidities and complications should they occur. As with any invasive surgical procedure, some candidates are more at-risk for complications with bariatric surgery. With constant improvements in research on this topic, we are hopeful to learn more about the long-term efficacy and safety of bariatric surgery in children and adolescents.
REFERENCES References available on request (
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Messehinweis.indd 1 22.03.2012 12:44:26
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