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Adolescent LAGB

Lap band surgery beneficial in very obese adolescents

. Weight and BMI improved significantly at all follow up times (all p<0.01) and the median maximum BMI loss was 10 [7.1–14.7]

Lap band surgery has significant benefits for severely obese teenagers and, despite its controversial nature, should still be considered as a first option to manage obesity during adolescence, according to a study published in Obesity Surgery. Led by University of Adelaide researchers, in collaboration with Flinders Medical Centre, the authors believe the study is the first to show medium to long-term follow-up (3-5 years) of lap band surgery in Australian adolescents.

Severe obesity is associated with serious physical and psychological conditions affecting quality of life. Revised Australian National Health and Medical Research Council guidelines for obesity management state that lap band surgery should be considered in adolescents with severe obesity with the presence of obesity-related diseases and who don't respond to medical treatment. However, there is no data available in Australian adolescents beyond 24 months post-surgery.

"We are talking about a group of adolescents with severe obesity and significant health and psychological problems related to their increased weight, this is not for everyone," said corresponding author and Paediatric Endocrinologist Dr Alexia Peña, who is a Senior Lecturer with the University of Adelaide's Robinson Research Institute.

The research paper, ‘Laparoscopic Adjustable Gastric Banding in Australian Adolescents: Should It Be Done?’, followed 21 severely obese teenagers between 14 and 18 years who had Laparoscopic Adjustable Gastric Banding (lap band surgery) in the South Australian Health Service, and sought to evaluate medium term (>36 months) safety and efficacy of LAGB in adolescents with severe obesity. The main outcome measures include change in weight and BMI at six, 12, 24, 36 and 48 months post LAGB; postoperative complications; and admissions.

Outcomes

Twenty-one adolescents (median [interquartile range (IQR)] 17.4 [16.5–17.7] years, nine males, mean ± SD BMI 47.3 ± 8.4) had a median follow up of 45.5 [32–50] months post LAGB. Follow up data were available for 16 adolescents. Weight and BMI improved significantly at all follow up times (all p<0.01) and the median maximum BMI loss was 10 [7.1–14.7]. There were four minor early complications. Seven bands were removed due to weight loss failure/regain (two had also obstructive symptoms).

"The median BMI reduction of 10 with the lap band is a good result when compared to BMI reduction using the few medications available or lifestyle measures, which is around 1-3 kg/m2," said Peña. "Lap band surgery is reversible and allows time for adolescents to mature to make a more informed decision on a permanent surgical procedure if required later on in life. This is not the case for other surgeries currently offered for obesity management. It is also important that teenagers undergoing this surgery have access to an experienced surgeon as part of a multidisciplinary paediatric team of doctors and Health professionals to ensure there is long-term regular follow-up."

"Although gastric banding has been controversial and is currently less used in adults with severe obesity, lap band surgery is one of the most studied surgeries for obesity management, has a high safety record and can be a temporary option to manage severe obesity during adolescence," said Mr Khurana, who is also a Senior Lecturer in the University of Adelaide's Discipline of Paediatrics. "Our findings support lap band surgery as a safe and effective option for management of adolescents with severe obesity, provided it is performed by an experienced surgeon and managed afterwards in a paediatric multidisciplinary environment with regular follow-up until adulthood."

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