BACKGROUND & AIMS Endoscopic bariatric therapies are less invasive alternatives and endoscopi... more BACKGROUND & AIMS Endoscopic bariatric therapies are less invasive alternatives and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims to compare weight loss, safety and comorbidity resolution of ESG compared to laparoscopic sleeve gastrectomy (LSG). METHODS This was a propensity score matched study of patients who underwent LSG or ESG. Primary outcome was weight loss at 6, 12, 24, and 36 months. A non-inferiority margin of 10% total weight loss (%TWL) was used. The secondary outcomes were safety and comorbidity resolution. RESULTS 1:1 propensity score matching yielded 3018 patient pairs. Average age and body mass index (BMI) were 34 ± 10 years and 33± 3 kg/m2, respectively and 89% were female. Mean %excess weight loss (%EWL) at one, two, and three years after ESG was 77.1 ± 24.6%, 75.2 ± 47.9%, and 59.7 ± 57.1% respectively. Mean %EWL at one, two, and three years after LSG was 95.1 ± 20.5%, 93.6 ± 31.3%, and 74.3 ± 35.2%, respectively. %TWL mean difference (95% confidence interval; p-value) was 9.7 (6.9-11.8; p<0.001) %, 6.0 (-2.0-9.4; p<0.001) % and 4.8 (-1.5-8.7; p<0.001) % at one, two, and three years, respectively. Non-inferiority was demonstrated at all follow-up visits. Fourteen ESG patients developed adverse events (0.5%) vs ten LSG patients (0.3%). Co-morbidity remission rates after ESG vs LSG were 64% vs 82% for diabetes, 66% vs 64% for dyslipidemia, and 51% vs 46% for hypertension, respectively. Eighty ESG patients (2.7%) underwent revision to LSG for insufficient weight loss or weight regain, and 28 had re-suturing after primary ESG (0.9%). CONCLUSIONS ESG induces non-inferior weight loss to LSG with similar co-morbidity resolution and safety profiles.
Background: Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS).... more Background: Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). Objectives: To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Setting: Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Methods: Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. Results: The 24 PWS patients (mean age 10.7; 6 o 8 yr old, range 4.9–18) had a preoperative BMI of 46.2 12.2 kg/m 2. All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was –14.7 (n ¼ 22 patients), –15.0 (n ¼ 18), 12.2 (n ¼ 13), –12.7 (n ¼ 11), and –10.7 (n ¼ 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of –15.9 (n ¼ 67), –18.0 (n ¼ 50), –18.4 (n ¼ 47), –18.9 (n ¼ 26), and –19.0 (n ¼ 20), respectively. No significant difference was observed in postoperative BMI change (P ¼ .2–.7) or growth (postoperative height z-score P value at each annual visit ¼ .2–.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P ¼ .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. Conclusions: PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective
Objective: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children ... more Objective: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study. Background: Debatable concerns result in denying young children access to bariatric surgery. Methods: Our multidisciplinary program database was used to extract data of young nonsyndromic children (age 14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age > 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth. Results: One hundred sixteen children younger than 14 years (mean AE SD, 11.2 AE 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 AE 2.0 years) who underwent LSG in our institution, children younger than 14 years had a significantly lower prevalence of comorbidities (P < 0.001) but similar resolution rates (P ¼ 0.72–0.99). There was no significant difference in the rate of complications (P ¼ 0.77), and no mortality or significant morbidity was observed in any of the groups. Conclusions: This study challenges existing concerns regarding the safety and efficacy of bariatric surgery in prepubertal children. LSG is evidently safe and effective in this age group, resulting in significant weight loss, improved growth, and resolution of comorbidities without mortality or significant morbidity.
Background
No verdict has been reached on single-stage removal of gastric banding with sleeve gas... more Background No verdict has been reached on single-stage removal of gastric banding with sleeve gastrectomy. Objectives To report 5-year outcomes of one-stage gastric band removal and sleeve gastrectomy (Conversion-LSG) compared to primary laparoscopic sleeve gastrectomy (Prim-LSG) Setting Large single-surgeon prospective database Methods Two patient groups were included: Conversion-LSG as the study group and Prim-LSG for comparison. Pre-conversion characteristics, conversion indication, weight loss, and complications were compared. The surgical protocol was reviewed focusing on key technical recommendations. Results 209 Conversion-LSG and 3,268 Prim-LSG patients were aged 32.9 ± 9.8 and 31.8 ± 10.7 years, respectively (p-value: 0.2). No significant differences in age, body mass index (BMI) and gender distribution existed. Conversion-LSG Baseline BMI was 47 ± 12. Patients spent 6.2 ± 2.6 years with the band before Conversion-LSG. BMI at 1, 2, 3, 4, and 5 years was 37 ± 8, 31 ± 9, 29 ± 11, 30 ± 9, and 30 ± 11, respectively. No significant difference in BMI change comparing the two groups existed. In the conversion-LSG group, one patient had a successfully stented leak, but he developed a gastrobronchial fistula 1 year later. In the Prim-LSG group, 3 leak cases were reported and managed successfully through endoscopic stenting. One other patient had pulmonary embolism that responded to standard treatment, and 3 patients had postoperative bleeding. No other major complications occurred, and there was no mortality in either groups. Conclusion Employing the surgical technique described in this paper, Conversion-LSG is as safe and effective as primary sleeve gastrectomy. Keywords: one-stage, sleeve gastrectomy, gastric band, concomitant, single-stage, revision, band removal
To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger tha... more To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study. Debatable concerns result in denying young children access to bariatric surgery. Our multidisciplinary program database was used to extract data of young nonsyndromic children (age ≤14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age > 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth. One hundred sixteen children younger than 14 years (mean ± SD, 11.2 ± 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 ± 2.0 years) who underwent LSG in our institution, children younger than 14 ye...
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, Jan 22, 2015
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study we... more Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. The 24 PWS patients (mean age 10.7; 6<8 yr old, range 4.9-18) had a preoperative BMI of 46.2±12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI chang...
To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger tha... more To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study. Debatable concerns result in denying young children access to bariatric surgery. Our multidisciplinary program database was used to extract data of young nonsyndromic children (age ≤14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age &amp;amp;gt; 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth. One hundred sixteen children younger than 14 years (mean ± SD, 11.2 ± 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 ± 2.0 years) who underwent LSG in our institution, children younger than 14 years had a significantly lower prevalence of comorbidities (P &amp;amp;lt; 0.001) but similar resolution rates (P = 0.72-0.99). There was no significant difference in the rate of complications (P = 0.77), and no mortality or significant morbidity was observed in any of the groups. This study challenges existing concerns regarding the safety and efficacy of bariatric surgery in prepubertal children. LSG is evidently safe and effective in this age group, resulting in significant weight loss, improved growth, and resolution of comorbidities without mortality or significant morbidity.
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study we... more Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. The 24 PWS patients (mean age 10.7; 6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8 yr old, range 4.9-18) had a preoperative BMI of 46.2±12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was -14.7 (n = 22 patients), -15.0 (n = 18), 12.2 (n = 13), -12.7 (n = 11), and -10.7 (n = 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of -15.9 (n = 67), -18.0 (n = 50), -18.4 (n = 47), -18.9 (n = 26), and -19.0 (n = 20), respectively. No significant difference was observed in postoperative BMI change (P = .2-.7) or growth (postoperative height z-score P value at each annual visit = .2-.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective alternative therapy is available.
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study we... more Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. The 24 PWS patients (mean age 10.7; 6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8 yr old, range 4.9-18) had a preoperative BMI of 46.2±12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was -14.7 (n = 22 patients), -15.0 (n = 18), 12.2 (n = 13), -12.7 (n = 11), and -10.7 (n = 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of -15.9 (n = 67), -18.0 (n = 50), -18.4 (n = 47), -18.9 (n = 26), and -19.0 (n = 20), respectively. No significant difference was observed in postoperative BMI change (P = .2-.7) or growth (postoperative height z-score P value at each annual visit = .2-.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective alternative therapy is available.
PURPOSE:
Despite the rising interest in bariatric surgery (BS) for children and adolescents, algo... more PURPOSE: Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. MATERIALS AND METHODS: Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. RESULTS: Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. CONCLUSIONS: Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.
Background:
Bariatric surgery is becoming important for the reversal of co-morbidities in childre... more Background: Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents. Methods: Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions. Results: The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively. Conclusion: LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.
BACKGROUND & AIMS Endoscopic bariatric therapies are less invasive alternatives and endoscopi... more BACKGROUND & AIMS Endoscopic bariatric therapies are less invasive alternatives and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims to compare weight loss, safety and comorbidity resolution of ESG compared to laparoscopic sleeve gastrectomy (LSG). METHODS This was a propensity score matched study of patients who underwent LSG or ESG. Primary outcome was weight loss at 6, 12, 24, and 36 months. A non-inferiority margin of 10% total weight loss (%TWL) was used. The secondary outcomes were safety and comorbidity resolution. RESULTS 1:1 propensity score matching yielded 3018 patient pairs. Average age and body mass index (BMI) were 34 ± 10 years and 33± 3 kg/m2, respectively and 89% were female. Mean %excess weight loss (%EWL) at one, two, and three years after ESG was 77.1 ± 24.6%, 75.2 ± 47.9%, and 59.7 ± 57.1% respectively. Mean %EWL at one, two, and three years after LSG was 95.1 ± 20.5%, 93.6 ± 31.3%, and 74.3 ± 35.2%, respectively. %TWL mean difference (95% confidence interval; p-value) was 9.7 (6.9-11.8; p<0.001) %, 6.0 (-2.0-9.4; p<0.001) % and 4.8 (-1.5-8.7; p<0.001) % at one, two, and three years, respectively. Non-inferiority was demonstrated at all follow-up visits. Fourteen ESG patients developed adverse events (0.5%) vs ten LSG patients (0.3%). Co-morbidity remission rates after ESG vs LSG were 64% vs 82% for diabetes, 66% vs 64% for dyslipidemia, and 51% vs 46% for hypertension, respectively. Eighty ESG patients (2.7%) underwent revision to LSG for insufficient weight loss or weight regain, and 28 had re-suturing after primary ESG (0.9%). CONCLUSIONS ESG induces non-inferior weight loss to LSG with similar co-morbidity resolution and safety profiles.
Background: Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS).... more Background: Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). Objectives: To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Setting: Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Methods: Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. Results: The 24 PWS patients (mean age 10.7; 6 o 8 yr old, range 4.9–18) had a preoperative BMI of 46.2 12.2 kg/m 2. All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was –14.7 (n ¼ 22 patients), –15.0 (n ¼ 18), 12.2 (n ¼ 13), –12.7 (n ¼ 11), and –10.7 (n ¼ 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of –15.9 (n ¼ 67), –18.0 (n ¼ 50), –18.4 (n ¼ 47), –18.9 (n ¼ 26), and –19.0 (n ¼ 20), respectively. No significant difference was observed in postoperative BMI change (P ¼ .2–.7) or growth (postoperative height z-score P value at each annual visit ¼ .2–.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P ¼ .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. Conclusions: PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective
Objective: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children ... more Objective: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study. Background: Debatable concerns result in denying young children access to bariatric surgery. Methods: Our multidisciplinary program database was used to extract data of young nonsyndromic children (age 14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age > 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth. Results: One hundred sixteen children younger than 14 years (mean AE SD, 11.2 AE 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 AE 2.0 years) who underwent LSG in our institution, children younger than 14 years had a significantly lower prevalence of comorbidities (P < 0.001) but similar resolution rates (P ¼ 0.72–0.99). There was no significant difference in the rate of complications (P ¼ 0.77), and no mortality or significant morbidity was observed in any of the groups. Conclusions: This study challenges existing concerns regarding the safety and efficacy of bariatric surgery in prepubertal children. LSG is evidently safe and effective in this age group, resulting in significant weight loss, improved growth, and resolution of comorbidities without mortality or significant morbidity.
Background
No verdict has been reached on single-stage removal of gastric banding with sleeve gas... more Background No verdict has been reached on single-stage removal of gastric banding with sleeve gastrectomy. Objectives To report 5-year outcomes of one-stage gastric band removal and sleeve gastrectomy (Conversion-LSG) compared to primary laparoscopic sleeve gastrectomy (Prim-LSG) Setting Large single-surgeon prospective database Methods Two patient groups were included: Conversion-LSG as the study group and Prim-LSG for comparison. Pre-conversion characteristics, conversion indication, weight loss, and complications were compared. The surgical protocol was reviewed focusing on key technical recommendations. Results 209 Conversion-LSG and 3,268 Prim-LSG patients were aged 32.9 ± 9.8 and 31.8 ± 10.7 years, respectively (p-value: 0.2). No significant differences in age, body mass index (BMI) and gender distribution existed. Conversion-LSG Baseline BMI was 47 ± 12. Patients spent 6.2 ± 2.6 years with the band before Conversion-LSG. BMI at 1, 2, 3, 4, and 5 years was 37 ± 8, 31 ± 9, 29 ± 11, 30 ± 9, and 30 ± 11, respectively. No significant difference in BMI change comparing the two groups existed. In the conversion-LSG group, one patient had a successfully stented leak, but he developed a gastrobronchial fistula 1 year later. In the Prim-LSG group, 3 leak cases were reported and managed successfully through endoscopic stenting. One other patient had pulmonary embolism that responded to standard treatment, and 3 patients had postoperative bleeding. No other major complications occurred, and there was no mortality in either groups. Conclusion Employing the surgical technique described in this paper, Conversion-LSG is as safe and effective as primary sleeve gastrectomy. Keywords: one-stage, sleeve gastrectomy, gastric band, concomitant, single-stage, revision, band removal
To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger tha... more To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study. Debatable concerns result in denying young children access to bariatric surgery. Our multidisciplinary program database was used to extract data of young nonsyndromic children (age ≤14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age > 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth. One hundred sixteen children younger than 14 years (mean ± SD, 11.2 ± 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 ± 2.0 years) who underwent LSG in our institution, children younger than 14 ye...
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, Jan 22, 2015
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study we... more Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. The 24 PWS patients (mean age 10.7; 6<8 yr old, range 4.9-18) had a preoperative BMI of 46.2±12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI chang...
To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger tha... more To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study. Debatable concerns result in denying young children access to bariatric surgery. Our multidisciplinary program database was used to extract data of young nonsyndromic children (age ≤14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age &amp;amp;gt; 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth. One hundred sixteen children younger than 14 years (mean ± SD, 11.2 ± 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 ± 2.0 years) who underwent LSG in our institution, children younger than 14 years had a significantly lower prevalence of comorbidities (P &amp;amp;lt; 0.001) but similar resolution rates (P = 0.72-0.99). There was no significant difference in the rate of complications (P = 0.77), and no mortality or significant morbidity was observed in any of the groups. This study challenges existing concerns regarding the safety and efficacy of bariatric surgery in prepubertal children. LSG is evidently safe and effective in this age group, resulting in significant weight loss, improved growth, and resolution of comorbidities without mortality or significant morbidity.
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study we... more Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. The 24 PWS patients (mean age 10.7; 6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8 yr old, range 4.9-18) had a preoperative BMI of 46.2±12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was -14.7 (n = 22 patients), -15.0 (n = 18), 12.2 (n = 13), -12.7 (n = 11), and -10.7 (n = 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of -15.9 (n = 67), -18.0 (n = 50), -18.4 (n = 47), -18.9 (n = 26), and -19.0 (n = 20), respectively. No significant difference was observed in postoperative BMI change (P = .2-.7) or growth (postoperative height z-score P value at each annual visit = .2-.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective alternative therapy is available.
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study we... more Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS). To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome. Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery. Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed. The 24 PWS patients (mean age 10.7; 6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8 yr old, range 4.9-18) had a preoperative BMI of 46.2±12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was -14.7 (n = 22 patients), -15.0 (n = 18), 12.2 (n = 13), -12.7 (n = 11), and -10.7 (n = 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of -15.9 (n = 67), -18.0 (n = 50), -18.4 (n = 47), -18.9 (n = 26), and -19.0 (n = 20), respectively. No significant difference was observed in postoperative BMI change (P = .2-.7) or growth (postoperative height z-score P value at each annual visit = .2-.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group. PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective alternative therapy is available.
PURPOSE:
Despite the rising interest in bariatric surgery (BS) for children and adolescents, algo... more PURPOSE: Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. MATERIALS AND METHODS: Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. RESULTS: Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. CONCLUSIONS: Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.
Background:
Bariatric surgery is becoming important for the reversal of co-morbidities in childre... more Background: Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents. Methods: Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions. Results: The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively. Conclusion: LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.
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No verdict has been reached on single-stage removal of gastric banding with sleeve gastrectomy.
Objectives
To report 5-year outcomes of one-stage gastric band removal and sleeve gastrectomy (Conversion-LSG) compared to primary laparoscopic sleeve gastrectomy (Prim-LSG)
Setting
Large single-surgeon prospective database
Methods
Two patient groups were included: Conversion-LSG as the study group and Prim-LSG for comparison. Pre-conversion characteristics, conversion indication, weight loss, and complications were compared. The surgical protocol was reviewed focusing on key technical recommendations.
Results
209 Conversion-LSG and 3,268 Prim-LSG patients were aged 32.9 ± 9.8 and 31.8 ± 10.7 years, respectively (p-value: 0.2). No significant differences in age, body mass index (BMI) and gender distribution existed. Conversion-LSG Baseline BMI was 47 ± 12. Patients spent 6.2 ± 2.6 years with the band before Conversion-LSG. BMI at 1, 2, 3, 4, and 5 years was 37 ± 8, 31 ± 9, 29 ± 11, 30 ± 9, and 30 ± 11, respectively. No significant difference in BMI change comparing the two groups existed.
In the conversion-LSG group, one patient had a successfully stented leak, but he developed a gastrobronchial fistula 1 year later. In the Prim-LSG group, 3 leak cases were reported and managed successfully through endoscopic stenting. One other patient had pulmonary embolism that responded to standard treatment, and 3 patients had postoperative bleeding. No other major complications occurred, and there was no mortality in either groups.
Conclusion
Employing the surgical technique described in this paper, Conversion-LSG is as safe and effective as primary sleeve gastrectomy.
Keywords: one-stage, sleeve gastrectomy, gastric band, concomitant, single-stage, revision, band removal
Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution.
MATERIALS AND METHODS:
Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only.
RESULTS:
Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients.
CONCLUSIONS:
Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.
Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents.
Methods:
Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions.
Results:
The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively.
Conclusion:
LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.
No verdict has been reached on single-stage removal of gastric banding with sleeve gastrectomy.
Objectives
To report 5-year outcomes of one-stage gastric band removal and sleeve gastrectomy (Conversion-LSG) compared to primary laparoscopic sleeve gastrectomy (Prim-LSG)
Setting
Large single-surgeon prospective database
Methods
Two patient groups were included: Conversion-LSG as the study group and Prim-LSG for comparison. Pre-conversion characteristics, conversion indication, weight loss, and complications were compared. The surgical protocol was reviewed focusing on key technical recommendations.
Results
209 Conversion-LSG and 3,268 Prim-LSG patients were aged 32.9 ± 9.8 and 31.8 ± 10.7 years, respectively (p-value: 0.2). No significant differences in age, body mass index (BMI) and gender distribution existed. Conversion-LSG Baseline BMI was 47 ± 12. Patients spent 6.2 ± 2.6 years with the band before Conversion-LSG. BMI at 1, 2, 3, 4, and 5 years was 37 ± 8, 31 ± 9, 29 ± 11, 30 ± 9, and 30 ± 11, respectively. No significant difference in BMI change comparing the two groups existed.
In the conversion-LSG group, one patient had a successfully stented leak, but he developed a gastrobronchial fistula 1 year later. In the Prim-LSG group, 3 leak cases were reported and managed successfully through endoscopic stenting. One other patient had pulmonary embolism that responded to standard treatment, and 3 patients had postoperative bleeding. No other major complications occurred, and there was no mortality in either groups.
Conclusion
Employing the surgical technique described in this paper, Conversion-LSG is as safe and effective as primary sleeve gastrectomy.
Keywords: one-stage, sleeve gastrectomy, gastric band, concomitant, single-stage, revision, band removal
Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution.
MATERIALS AND METHODS:
Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only.
RESULTS:
Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients.
CONCLUSIONS:
Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.
Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents.
Methods:
Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions.
Results:
The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively.
Conclusion:
LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.