PHOENIX — Benefits and complications resulting from Roux-en-Y gastric bypass procedures are similar for both adolescents and adults, according to data presented by Mike K. Chen, M.D., at the annual meeting of the American Pediatric Surgical Association.
A multicenter review of 37 adolescents who underwent the procedure showed that average body mass index decreased by 20.7 kg/m
“While there are considerable risks with bariatric surgery, early experience suggests that these risks are offset by health benefits in these patients,” Dr. Chen said.
Five surgeons performed the operations on adolescents aged 13–21 years at three pediatric centers: Dr. Chen's institution, Children's Hospital of Alabama (University of Alabama, Birmingham), and Cincinnati Children's Hospital Medical Center (University of Cincinnati).
In 36 cases, the surgeons attempted laparoscopic procedures. Two were converted to open procedures, however, bringing to three the number of open procedures in the sample. Roux limb lengths were reported as 75–150 cm, and gastric pouch size as 30–45 cc.
Average body mass index at baseline was 56.5 kg/m
Dr. Chen itemized the metabolic data as follows: fasting insulin decreased by 21.3 μU/mL in 14 patients, fasting glucose by 12 g/dL in 10 patients, homeostasis model assessment-insulin resistance (HOMA-IR) by 4.6 in 9 patients, triglycerides by 65.1 mg/dL in 17 patients, and total cholesterol by 29.7 mg/dL in 18 patients.
Because of the small sample size, Dr. Chen and his coauthors did not calculate rates for individual complications but reported adverse events in categories.
They classified a complication as minor if the patient was readmitted to the hospital for less than 7 days of treatment, which could be endoscopy or diagnostic studies. Nine adolescents had minor complications, identified as endoscopy, food obstruction, wound infection, stricture, dumping syndrome secondary to overeating, mild beriberi that responded to outpatient treatment, hypokalemia, and deep vein thrombosis.
The investigators defined a moderate complication as unanticipated admission to an intensive care unit, reoperation, or sequelae lasting 7–30 days. Four patients had moderate complications. Dr. Chen listed these as persistent iron deficiency anemia, peripheral neuropathy secondary to vitamin deficiency, reoperation, shock, or internal hernia. He said the reasons for reoperation were staple line leak, obstruction, and gastrostomy revision.
A severe complication could be a life-threatening event, a major organ system failure, or sequelae lasting more than 30 days. Only two patients had a severe complication: a teenager who died 9 months after surgery from colitis that developed during rehabilitation for osteoarthritis, and one who experienced beriberi with sequelae for 2 months. The rest of the complications were mild to moderate, and 22 patients (61%) had none at all.
Dr. Chen said the surgeons undertook the analysis in response to a call for outcome studies in recently published guidelines for bariatric surgery in patients between the ages of 13 and 21 (Pediatrics 2004;114:217–23).
He cited one previous report of efficacy and complication rates, noting it was limited to 33 adolescents treated over 20 years at a single adult institution (J. Gastrointest. Surg. 2003;7:102–7).
“The vast majority of patients who undergo bariatric surgery are adults in their fifth decade of life,” Dr. Chen said, adding that outcome data clearly support the procedure's efficacy in the older population.
About 15.5% of adolescents are overweight, he said, adding that “50%–75% of these obese kids become obese adults.” Without a successful intervention, he warned, the consequences can include physical and psychosocial conditions and lost years of life.