Clinical efficacy of metabolic surgery on obese adolescents

Abstract

Objective To explore the clinical effects of metabolic surgery on obese adolescents. Methods The clinical data of 28 obese adolescents who were admitted to the First Affiliated Hospital of Nanjing Medical University from June 2010 to January 2014 were retrospectively analyzed. Patients underwent gastric bypass and sleeve gastrectomy according to their own intention and were followed up regularly at 1, 3, 6, 9 months after surgery till October 2014. The perioperative conditions and postoperative effecacies of patients were observed. The measurement data with normal distribution were presented as ±s, the comparisons of weight-loss trends among different surgeries were analyzed by the repeated measures ANOVA. Results All surgeries were performed under laparoscope without severe complications or deaths, including 16 cases of gastric bypass and 12 cases of sleeve gastrectomy. The median operation time and duration of postoperative stay were 136.5 minutes (range, 60.0-320.0 minutes) and 4 days (range, 2-8 days), respectively. Three patients had perioperative complications. All patients received postoperative follow-ups. The median body mass index(BMI) at postoperative month 1, 3, 6, 9 were 36.1 kg/m2, 33.2 kg/m2, 30.2 kg/m2 and 28.4 kg/m2, and mean excess weight loss (EWL) rate were 24.6%, 40.4%, 55.1% and 63.9%. The BMIs before operation and at postoperative month 1, 3, 6, 9 were (43±6)kg/m2, (37±5)kg/m2, (34±4)kg/m2, (30±4)kg/m2 and (29±4)kg/m2 in patients undergoing gastric bypass, and (39±4)kg/m2, (35±4)kg/m2, (32±5)kg/m2, (31±4)kg/m2 and (28±4)kg/m2 in patients undergoing sleeve gastrectomy, respectively. The EWL at postoperative month 1, 3, 6, 9 were 24%±9%, 40%±9%, 59%±12% and 65%±12% in patients undergoing gastric bypass, and 25%±9%, 41%±15%, 49%±16% and 63%±17% in patients undergoing sleeve gastrectomy, respectively. There was no difference in the change of BMI and EWL between gastric bypass and sleeve gastrectomy (F=0.777, 0.332, P>0.05). Four patients undergoing gastric bypass were found to have nutritional complications in follow-up and recovered after symptomatic treatment. Conclusion Bariatric surgery is safe and feasible for obese adolescents with a signifi-cant weight loss. However relevant nutrition complications may occur, it is significant to sustain a long-term follow-up and nutrition intervention, and the choice of surgical procedures should follow the principle of individuation. Key words: Obesity; Adolescent; Bariatric surgery; Laparoscopy