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Adolescent bariatric surgery

Sleeve and RYGB maintain weight loss after adolescent surgery

At one year, RYGB was associated with BMI loss of 31.4% vs 28% for SG (p<0.001)

Adolescents undergoing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) experienced the greatest decline in BMI and in large part maintained this weight loss over the five-year follow-up time period, while patients undergoing adjustable gastric banding (AGB) lost the least weight, according to a studied lead by researchers from PCORnet Bariatric Study Collaborative.

In the paper, ‘Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study’, published in SOARD, the authors explain that most studies examining bariatric surgery to treatment adolescents with severe obesity have been small with limited follow-up. Therefore, they obtained data from the National Patient Centered Clinical Research Network (PCORnet) to compare effectiveness of bariatric procedures (RYGB, SG and AGB) in adolescents - in what the authors claim is the largest study of adolescents undergoing bariatric surgery to date.

In total, 544 adolescents patients were included in this study (female 79%, white 66%), with mean age of 17.3±1.6 years and mean BMI of 49.8±7.8. Most patients underwent SG (n=306), then RYGB (n=177) and AGB (n=61) (Figure 1).

Figure 1: Procedure prevalence over time

Obstructive sleep apnoea (36%) was the most common co-morbidity, followed by dyslipidemia (35%), hypertension (32%), depression (28%), gastroesophageal reflux disease (25%), polycystic ovary syndrome (22%), non-alcoholic fatty liver disease (19%) and type 2 diabetes (16%). The number of individuals with sufficient follow-up weight data for inclusion after one-, three-, and five-year analyses was 524, 174 and 47, respectively.


There were no perioperative deaths and subsequent percutaneous, endoscopic or subsequent operative procedures were seen in only 3.3% of patients and 4.41% (n=24) of patients had an adverse events within 30 days. Venous thromboembolic events were observed in only 0.4% and failure to discharge in 30 days was observed in only 0.7%.

Adolescents had comparable baseline BMI (49-51) and those who underwent RYGB and SG experienced the greatest reduction in BMI at each time point during follow-up. At one year, RYGB was associated with BMI loss of 31.4% vs 28% for SG (p<0.001). At three years, RYGB patients experienced a five percentage point greater BMI loss (p=0.051) vs SG (Figure 2). At five years, five patients who underwent RYGB maintained an average (unadjusted) loss of 24% of their baseline BMI vs 21% for SG, although the authors acknowledge that there are insufficient numbers to make a statistical comparison.

Figure 2: Percentage change in body mass index through three years after bariatric surgery, by procedure type

For patients undergoing AGB, they lost an estimated 10% of baseline BMI, compared with patients RYGB who lost 22% (p<0.0001) greater decrease in BMI, while those undergoing SG had an 18% (p< 0.0001) greater decrease in BMI. Unfortunately, there was insufficient data beyond one year for meaningful comparisons between AGB and other procedures, however, the authors stated that trends suggested no further reduction in BMI among those who underwent AGB.

“It is also important to consider that while very few adverse events were recorded for any of the procedures, the vertical SG is the only irreversible procedure of the three evaluated, and this fact should be weighed when comparing risks of each of these procedures,” the authors added. “Furthermore, a greater proportion of RYGB than SG patients achieved 30% weight loss, suggesting that RYGB may be a superior procedure for patients with the most severe levels of obesity.”

Interestingly, the authors noted that weight loss after SG at five years was 20%, weight regain between one and five years demonstrated why adolescent patients should be followed over the long term to access the durability of SG procedure, as well as patients’ lifestyle choices on their long-term weight loss/gain.

“Understanding how these procedures impact long-term weight loss helps patients, families, and healthcare providers have more informed conversations about the potential benefits of surgical treatment of severe obesity in adolescents,” concluded the researchers. “Further long-term studies addressing how these bariatric procedures impact not only BMI but also nutrition, risk of adverse events, and obesity-related physical and mental health co-morbidities are needed.”

To access this paper, please click here

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