Which Surgical Specialist Should Perform Metabolic Bariatric Surgery in Children and Adolescents?

Abstract

As the incidence of obesity has risen in North American children and adolescents, there has been a concomitant rise in the number of pediatric patients who undergo metabolic bariatric surgery (MBS). Over the past 3 decades there has been a three-fold increase in the incidence of childhood obesity [1]. For adolescents age 12 to 19 years, the prevalence of obesity and extreme obesity is estimated at 20.5% and 7.8% respectively, and for children as young as 6 to 11 years of age it is estimated to be 17.5% and 5.6% [2]. While metabolic and bariatric surgery (MBS) has a proven record of success in the treatment of adults with morbid obesity, it is only over the past decade or so that we have seen a similar rise in literature supporting MBS for the pediatric population. Adolescents undergoing MBS exhibit similar improvements in obesity-related conditions, such as diabetes type II, hypertension and obstructive sleep apnea [3–7]. For the most part, the result of MBS mirror the successes seen in adult populations, and a growing body of evidence similarly supports a multidisciplinary approach to MBS in pediatric patients. The American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee continues to put out pediatric-specific recommendations for MBS programs with respect to how a program is staffed. With respect to the surgeon performing the procedures, it recommends a “moderate volume metabolic and bariatric surgeon, either adult or pediatric, and a transition plan into an adult program [8].” The question we will consider in this review is whether the training background of that surgical specialist affects outcomes, and whether it makes a difference if that is a pediatric general surgeon or an adult surgeon with minimally invasive surgical (MIS) training?