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LRYGB in adolescents

Seven-year outcomes of LRYGB in adolescents

Study shows LRYGB is safe, provides good weight loss and cure comorbidities in an adolescent population

The seven years outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) in adolescents has report that the procedure appears to be safe, achieve good weight loss and resolve comorbidities in adolescents (<18 years). The paper, ‘Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years)’, by researchers from AZ St-Blasius, Dendermonde, Belgium, and published in the journal Obesity Facts, also reported a high degree of satisfaction with the procedure amongst patients. Nevertheless, the authors did caution that ‘inadvertent pregnancy despite conventional contraception’ is a possible concern.

Despite the ever increasing data on adult bariatric surgery, their still remains a limited number of papers reagrding adolescent patients. As a result, the study authors retrospectively assessed the long-term outcomes after LRYGB in 28 adolescents (childhood group; ChG) who were treated by LRYGB, 19 of which were available for follow-up between 2.4 and 10.2 years (mean 7.2 years). The ChG were then matched with an adult control group (AdG) of randomly chosen patients with similar characteristics who underwent LRYGB during the same period.

The authors reported no significant differences between the two groups in terms of gender, BMI, and mean follow-up time with 15 females in the ChG and 14 in the AdG. The mean baseline BMI for the ChG at the time of the procedure was 38.9 (range 35-44 kg/m2) and for the AdG it was 39.4 (range 35-45 kg/m2). At baseline, three adolescents had unsuspected T2DM, five dyslipidaemia, one from sleep apnoea and one from hypertension. In the AdG, four patients had T2DM, four had hypertension, six dyslipidaemia and one sleep apnoea.

Outcomes

The mean follow-up times were similar (7.2 years for the ChG and 7.7 years for the AdG) between the groups. In the ChG, one patient required a laparoscopic reoperation for an internal hernia, compared with three in the AdG who needed a reoperation for obstruction (n =2) or leak (n=1).

Mean BMI at follow-up was 27.5 (range: 21.8-35.2 kg/m2) in the ChG and 23.4 (16.2-28.1 kg/m2) in the AdG (BMI loss was not significant between the two groups, p=0.235), with all patients from both groups recovering from their initial comorbidities.

Thirteen patients from the AdG adhered to a strict follow-up regime with blood analyses (2-4 analyses per year) and adequate vitamins intake (compliance 72%). In the ChG, 16 adolescents were controlled but three claimed not having any type of follow-up despite advice and denied vitamins intake. Also in the AdG, five patients had blood work on a regular basis and six denied vitamin intake.

Two out of 12 female patients (17%) of the ChG who were taking classical contraceptive measures became pregnant six or eight years after the surgery despite use of an oral contraceptive. Six out of nine patients (66%) who did want children became pregnant and delivered without problems.

With regards to the degree of satisfaction after the procedure, both groups appeared satisfied (8.2 in the ChG and 8.9 in the AdG). Most of the patients of both groups (82% in the ChG and 78% in the AdG) would be willing to undergo a similar procedure to treat their obesity.

“As for adults, childhood obesity treatment should include measures to promote changes in lifestyle, eating habits, self-esteem, and family communication [20]. However, a significant percentage of patients will not be able to reverse their obesity and may consider surgical treatment,” the authors write. “ Changes induced by bariatric surgery in adolescents will mitigate the deleterious effects of morbid obesity, but this should not disturb the brittle overall equilibrium of the adolescent.”

“In our opinion the adjustable band, while removable, does leave irreversible changes around the cardia, and may permanently damage the lower oesophageal sphincter,” they added. “This is the reason why we abandoned the adjustable band procedure in 2004 in our department. Conversely, the bypass procedure is indeed fully reversible.”

The authors said that most of the adolescent patients showed a high compliance rate in terms of vitamin intake and regular blood work (84%) and the procedure did not seem to jeopardise the normal growth and development of their adolescent patients.

They also discussed undesired pregnancy and stated that the reduced activity of the contraceptive pill after LRYGB may be due to altered pharmacokinetics of the drug due to the bypass anatomy. Therefore, they would suggest that considering the abnormally high rate of unexpected pregnancy after the procedure, the contraceptive pill should no longer be proposed as a reliable means of birth control. Fertility is known to improve after bariatric surgery, however, they add that special attention must be paid to adolescents in order to avoid undesired pregnancies.

“The alarmingly increasing rate of childhood and adolescent obesity in most countries must urgently be addressed. Surgical treatment includes many modalities such as LAGB or LSG but aspects such as reversibility or long-term failure and new onset of GERD must be considered,” they conclude. “In our experience, LRYGB, a reversible procedure, appears to be an effective and well-accepted treatment mode for adolescent patients. Special attention must be paid to the use of birth control pills to avoid undesired pregnancy.”

The article was edited from the original article, under the Creative Commons license. To access the article, please click here

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