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Adolescent surgery

AMOS: Positive long-term results for adolescent surgery

The outcomes showed the change in bodyweight in adolescent surgical patients over 5 years was −36.8 kg (95% CI −40·9 to −32.8), resulting in a reduction in BMI of −13.1kg

Outcomes from adolescent bariatric surgery are equally as good as for adults, but the operations carries complications. Five year results from the Adolescent Morbid Obesity Surgery (AMOS) study revealed that patients weighed on average 28 per cent less than before surgery.

"Teenagers and adults who have undergone bariatric surgery exhibit remarkable similarities," said Professor Torsten Olbers, docent at the Sahlgrenska Academy and consultant at Sahlgrenska University Hospital. "Seriously obese young people who do not have surgery continue instead to increase in weight."

AMOS

AMOS is a Swedish nationwide study that recruited 82 adolescents between February 2006 and April 2009, with 81 patients (35% boys) having surgery. The study also included a control group of 81 conservatively managed adolescents (43% boys). The teenagers who were operated on were between 13 and 18 at the time of surgery, with an average age of 16 and an average BMI of around 45. In many cases, their obesity had already caused complications, such as altered blood lipid levels, high blood pressure, fatty liver, type 2 diabetes or a precursor of diabetes.

The study compared the 81 teenagers who had a gastric bypass with an equal number of teenagers in receipt of conventional treatment and a group of adults who had also had a gastric bypass (65 per cent were women and 35 per cent men). The outcomes, ‘Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study’, were published in The Lancet Diabetes & Endocrinology.

The outcomes showed the change in bodyweight in adolescent surgical patients over 5 years was −36.8 kg (95% CI −40·9 to −32.8), resulting in a reduction in BMI of −13.1kg (95% CI −14·5 to −11.8), although weight loss less than 10% occurred in nine (11%). The mean BMI rose in adolescent controls (3.3kg/m2, 95% CI 1·1–4·8) over the five-year study period, whereas the BMI change in adult controls was similar to that in adolescent surgical patients (mean change −12.3 kg/m2, 95% CI −13·7 to −10.9).

The comorbidities and cardiovascular risk factors in adolescent surgical patients showed improvement over five years and compared favourably with those in adolescent controls. Twenty (25%) of 81 adolescent surgical patients underwent additional abdominal surgery for complications of surgery or rapid weight loss and 58 (72%) showed some type of nutritional deficiency; health-care consumption (hospital attendances and admissions) was higher in adolescent surgical patients compared with adolescent controls.

"It is the most seriously obese young people we're talking about, and without surgery virtually all of them remain large for the rest of their lives," added Olbers. "It is especially evident in the young people that there is a strong underlying genetic predisposition for serious obesity. This is no lifestyle choice they have made. It came as a surprise to us that young people also had gall stones, something that we have seen in adults with severe weight loss. The young people also had the same frequency of ileus as the adults, a complication that we can now prevent by closing the so-called 'slits' during surgery."

"It's time to start integrating bariatric surgery with the treatment of seriously obese young people," said Dr Claude Marcus, professor of paediatrics at Karolinska Institutet. "But they must be monitored over the long term since our results also show that some young people need a lot of support to handle the post-operative situation. Bariatric surgery is no quick fix."

This study was funded by the Swedish Research Council; Swedish Governmental Agency for Innovation Systems; National Board of Health and Welfare; Swedish Heart and Lung Foundation; Swedish Childhood Diabetes Foundation; Swedish Order of Freemasons Children's Foundation; Stockholm County Council; Västra Götaland Region; Mrs Mary von Sydow Foundation; Stiftelsen Göteborgs Barnhus; Stiftelsen Allmänna Barnhuset; and the US National Institute of Diabetes, Digestive, and Kidney Diseases (National Institutes of Health).

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