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AMOS: adolescent bariatric surgery outcomes

The researchers noted “substantial and broad improvements” in cardiovascular risk factors

Adolescent bariatric surgery for adolescents can offer substantial weight loss and improvements both in health and quality of life similar to those reported in adults, although additional studies are required to determine the long-term outcomes. This is just one of the conclusions from the latest paper from the Adolescent Morbid Obesity Surgery (AMOS) project collaborators from Sahlgrenska University Hospital, Gothenburg, Sweden.

“Bariatric surgery is certainly not the only answer to tackle the obesity epidemic in adolescents, and effective prevention and conservative treatment strategies are urgently needed,” they state. “However, bariatric surgery appears to offer significant benefits for adolescents suffering from severe obesity.”

As well as discussing the various treatment strategies of adolescent obesity and some of the concerns of performing bariatric surgery on teenagers, the paper, ‘Bariatric surgery in adolescents: what do we know so far?‘ published in the Scandinavian Journal of surgery also assess particular considerations in adolescent obesity surgery such as the patients mind set, the role of the family and the important role an experienced multidisciplinary team (MDT) will play.

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 surgical group reported an excess weight loss >50% in almost all (95%) of patents, compared with a weight gain of 3% in the conventionally treated adolescents. There were no significant differences in weight loss between genders. In the surgical group, 57% had a continuing weight loss, while 43% reported increased weight during the second year after surgery (range −9·7 to +4·2 kg).

The researchers noted “substantial and broad improvements” in cardiovascular risk factors (glucose metabolism, blood lipids, inflammatory markers, as well as systolic and diastolic blood pressure), as well as significant improvements in quality of life, compared to baseline.

During the two-year follow-up, 12 adolescents (15%) underwent additional surgical interventions (mostly for internal hernia and cholecystectomies), five patients (6%) required surgery for internal hernia (three behind jejunojenunostomy and two at Petersen’s space), and five (6%) underwent cholecystectomy due to symptomatic gallstones. One patient was laparoscopically operated with a finding of adhesions and another underwent emergency laparotomy due to abdominal pain without obvious pathology. Four others (5%) visited an emergency ward due to non-specific abdominal pain.

“In summary, the Adolescent Morbid Obesity Surgery (AMOS) project demonstrates that gastric bypass surgery results in similar weight loss in adolescents with high prevalence of psychopathology as in adults over two years,” the authors conclude. “Furthermore, we found a substantial improvement in cardiovascular risk factors and quality of life. Nonetheless, the psychiatric adverse events appearing in this psychosocially vulnerable cohort require careful attention and might indicate limitations of the surgical strategy.”

To access this paper, please click here

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