Healthcare

During assess trends and outcomes for weight loss surgery or bariatric surgery in adolescents, research show that adolescents younger than 21 years more popular with laparoscopic adjustable gastric banding (LAGB) or lap band as their obesity treatment.

Instead this weight loss surgery had lower short-term complication than laparoscopic Roux-en Y gastric bypass (LRYGB), the research also show that use of LRYGB decreased in this age group.

Reported on September 20 of Pediatric, the authors of study, Howard C. Jen, MD, MSHS, from the University of California-Los Angeles School of Medicine, and colleagues write, “There has been a dramatic increase in the use of adolescent bariatric surgery, however, previous studies were unable to distinguish laparoscopic versus open procedures. Furthermore, the use of LAGB has not been studies on a population level.”

Despite the complication from weight loss surgery are frequent both during initial hospital stay or complication in the subsequent couple months such as rapid gastric emptying (bloating, diarrhea, necessitating small meals or medication), leaks at the surgical site, a bulge at or near the area of a surgical incision, infections, pneumonia, and mortality, however, this weight loss surgery had long-term significantly of weight loss.
As this weight loss surgery also had the risk of mortality, therefore, it should be performed by an experienced surgeon with following guideline recommendation.
Current guideline from the American College of Physicians, “Surgery should be considered as a treatment option for patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. A doctor–patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gallbladder disease, and malabsorption.” Also, “Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery.”

In this study, the investigators use the California Office of Statewide Health Planning and Development database to identified patients younger than 21 years who had elective bariatric surgery between 2005 and 2007 that involved 590 patients aged 13 to 20 years at 86 hospitals underwent bariatric surgery. Factor associated with the type of surgery were identified using multivariate logistic regression.

Although white adolescents accounted for only 28% of those who were overweight, the had 65% of the identified surgeries.
In their investigation results, the rates of LAGB use increased from 0.3 to 1.5 per 100,000 population (P < .01), but in the same time, LRYGB use decreased from 3.8 to 2.7 per 100,000 population (P < .01).
In addition, compared with privately insured adolescents, self-players were more likely to have LAGB and less likely to have LRYGB.

In the report, there is 1% rate of major in-hospital complications and no death findings. Due to need of band revision or removal, the investigators found in 4.7% of those who underwent LAGB, whereas repeat surgery was 2.9 of those who received LRYGB.

The authors write, “White adolescent girls disproportionately underwent bariatric surgery, although LAGB has not been approved by the US Food and Drug Administration for use in children, its use has increased dramatically.”

Despite the study have several limitations such as lacking important clinical (related to BMI) and physiologic (severity of comorbidities) information from administrative data and not accounted for by International Classification of Diseases, 9th Revision, coding, and observational data subject to potential source of bias. Also, the results may underestimate the total number of adolescents who had bariatric surgery and cannot confirm whether patients included in the study met recommended guidelines for bariatric surgery, the study authors conclude, “Although LRYGB is still the standard of care for morbidly obese adolescents who seek surgical intervention, our study of adolescent bariatric surgery in California between 2005 and 2007 revealed a dramatic increase in the use of LAGB.”
They add, “Additional studies on the efficacy, safety, and health care costs of weight-loss surgery in the adolescent population are needed to properly counsel patients and to help guide health policy.”