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Eur J Pediatr Surg 2016; 26(06): 487-493
DOI: 10.1055/s-0035-1570104
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Laparoscopic Sleeve Gastrectomy versus Gastric Bypass in Late Adolescents: What Is the Optimal Surgical Strategy for Morbid Obesity?

Stefanie Ramona van Mil
1   Department of Surgery, Sint Franciscus Vlietland Gasthuis, Rotterdam, The Netherlands
,
Laser Ulas Biter
1   Department of Surgery, Sint Franciscus Vlietland Gasthuis, Rotterdam, The Netherlands
,
Brechtje Aleid Grotenhuis
2   Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
,
Johannes Franciscus Zengerink
1   Department of Surgery, Sint Franciscus Vlietland Gasthuis, Rotterdam, The Netherlands
,
Guido Hein Huib Mannaerts
1   Department of Surgery, Sint Franciscus Vlietland Gasthuis, Rotterdam, The Netherlands
3   Department of Surgery, Tawam Hospital, Al Ain, United Arab Emirates
› Author Affiliations
Further Information

Publication History

22 April 2015

07 November 2015

Publication Date:
08 January 2016 (online)

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Abstract

Introduction Interest in bariatric surgery in adolescents is increasing, because adolescent obesity equals increased health risks in adult life. To define the preferred procedure in adolescents, this study compares outcomes of LSG and LRYGB in late adolescents in our center.

Materials and methods Data on baseline characteristics, operative details, and follow-up were collected retrospectively in all patients (age 18–20 years) who underwent LSG or LRYGB in our clinic. Outcomes were analyzed using nonparametric tests.

Results Total 65 adolescents (54 females; median age 19 years) were included, 45 patients underwent LSG, and 20 underwent LRYGB.

Significant differences in %EWL were observed at 2-year follow-up; 81.0% in LRYGB (n = 11) versus 96.8% in LSG (n = 23), p = 0.007. No differences were observed in postoperative mortality, complication rate, and resolution of comorbidities between both procedures.

Discussion LSG showed significant better results than LRYGB in terms of %EWL after 2 years in this selected group of late adolescents. Considering these results in LSG patients and the theoretical advantages of LSG (normal diet options, preservation of an intact GI-tract, less vitamin disturbances, and better quality of life), LSG may be an appropriate bariatric technique to perform in morbidly obese adolescents.

Keywords

morbid obesity - adolescents - bariatric surgery - gastric bypass - sleeve gastrectomy
 

  • References

  • 1 Black JA, White B, Viner RM, Simmons RK. Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis. Obes Rev 2013; 14 (8) 634-644
    CrossrefPubMedGoogle Scholar
  • 2 Inge TH, Krebs NF, Garcia VF , et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics 2004; 114 (1) 217-223
    CrossrefPubMedGoogle Scholar
  • 3 Paulus GF, de Vaan LEG, Verdam FJ, Bouvy ND, Ambergen TAW, van Heurn LWE. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis. Obes Surg 2015; 25 (5) 860-878
    CrossrefPubMedGoogle Scholar
  • 4 Alqahtani A, Alamri H, Elahmedi M, Mohammed R. Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study. Surg Endosc 2012; 26 (11) 3094-3100
    CrossrefPubMedGoogle Scholar
  • 5 Austin H, Smith KC, Ward WL. Bariatric surgery in adolescents: what's the rationale? What's rational?. Int Rev Psychiatry 2012; 24 (3) 254-261
    CrossrefPubMedGoogle Scholar
  • 6 Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA 2003; 289 (14) 1813-1819
    CrossrefPubMedGoogle Scholar
  • 7 Strauss RS, Pollack HA. Social marginalization of overweight children. Arch Pediatr Adolesc Med 2003; 157 (8) 746-752
    CrossrefPubMedGoogle Scholar
  • 8 Kolotkin RL, Crosby RD, Williams GR, Hartley GG, Nicol S. The relationship between health-related quality of life and weight loss. Obes Res 2001; 9 (9) 564-571
    CrossrefPubMedGoogle Scholar
  • 9 Barnett SJ. Bariatric surgical management of adolescents with morbid obesity. Curr Opin Pediatr 2013; 25 (4) 515-520
    CrossrefPubMedGoogle Scholar
  • 10 Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg 2012; 256 (2) 266-273
    CrossrefPubMedGoogle Scholar
  • 11 Gadiot RPM, Biter LU, Zengerink HJF , et al. Laparoscopic sleeve gastrectomy with an extensive posterior mobilization: technique and preliminary results. Obes Surg 2012; 22 (2) 320-329
    CrossrefPubMedGoogle Scholar
  • 12 Alexandrou A, Armeni E, Kouskouni E, Tsoka E, Diamantis T, Lambrinoudaki I. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis 2014; 10 (2) 262-268
    CrossrefPubMedGoogle Scholar
  • 13 Elte JWF, Castro Cabezas M, Vrijland WW, Ruseler CH, Groen M, Mannaerts GHH. Proposal for a multidisciplinary approach to the patient with morbid obesity: the St. Franciscus Hospital morbid obesity program. Eur J Intern Med 2008; 19 (2) 92-98
    CrossrefPubMedGoogle Scholar
  • 14 Aghajani E, Jacobsen HJ, Nergaard BJ, Hedenbro JL, Leifson BG, Gislason H. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg 2012; 16 (3) 641-645
    CrossrefPubMedGoogle Scholar
  • 15 Beamish AJ, Johansson SE, Olbers T. Bariatric surgery in adolescents: what do we know so far?. Scand J Surg 2015; 104 (1) 24-32
    CrossrefPubMedGoogle Scholar
  • 16 Fitzgerald DA, Baur L. Bariatric surgery for severely obese adolescents. Paediatr Respir Rev 2014; 15 (3) 227-230
    PubMedGoogle Scholar
  • 17 Till H, Blüher S, Hirsch W, Kiess W. Efficacy of laparoscopic sleeve gastrectomy (LSG) as a stand-alone technique for children with morbid obesity. Obes Surg 2008; 18 (8) 1047-1049
    CrossrefPubMedGoogle Scholar
  • 18 Pedroso FE, Gander J, Oh PS, Zitsman JL. Laparoscopic vertical sleeve gastrectomy significantly improves short term weight loss as compared to laparoscopic adjustable gastric band placement in morbidly obese adolescent patients. J Pediatr Surg 2015; 50 (1) 115-122
    CrossrefPubMedGoogle Scholar
  • 19 Raziel A, Sakran N, Szold A , et al. Mid-term follow-up after laparoscopic sleeve gastrectomy in obese adolescents. Isr Med Assoc J 2014; 16 (1) 37-41 . Accessed April 15, 2015, http://www.ncbi.nlm.nih.gov/pubmed/24575503
    PubMedGoogle Scholar
  • 20 Nadler EP, Barefoot LC, Qureshi FG. Early results after laparoscopic sleeve gastrectomy in adolescents with morbid obesity. Surgery 2012; 152 (2) 212-217
    CrossrefPubMedGoogle Scholar
  • 21 Herget S, Rudolph A, Hilbert A, Blüher S. Psychosocial status and mental health in adolescents before and after bariatric surgery: a systematic literature review. Obes Facts 2014; 7 (4) 233-245
    CrossrefPubMedGoogle Scholar
  • 22 Aldaqal SM, Sehlo MG. Self-esteem and quality of life in adolescents with extreme obesity in Saudi Arabia: the effect of weight loss after laparoscopic sleeve gastrectomy. Gen Hosp Psychiatry 2013; 35 (3) 259-264
    CrossrefPubMedGoogle Scholar
  • 23 Lennerz BS, Wabitsch M, Lippert H , et al. Bariatric surgery in adolescents and young adults—safety and effectiveness in a cohort of 345 patients. Int J Obes (Lond) 2014; 38 (3) 334-340
    CrossrefPubMedGoogle Scholar
  • 24 Montero PN, Stefanidis D, Norton HJ, Gersin K, Kuwada T. Reported excess weight loss after bariatric surgery could vary significantly depending on calculation method: a plea for standardization. Surg Obes Relat Dis 2011; 7 (4) 531-534
    CrossrefPubMedGoogle Scholar
  • 25 Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg 2013; 257 (2) 231-237
    CrossrefPubMedGoogle Scholar
  • 26 Lee DY, Guend H, Park K , et al. Outcomes of laparoscopic Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding in adolescents. Obes Surg 2012; 22 (12) 1859-1864
    CrossrefPubMedGoogle Scholar
  • 27 Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol 2014; 2 (2) 152-164
    CrossrefPubMedGoogle Scholar
  • 28 Oberbach A, Neuhaus J, Inge T , et al. Bariatric surgery in severely obese adolescents improves major comorbidities including hyperuricemia. Metabolism 2014; 63 (2) 242-249
    CrossrefPubMedGoogle Scholar
  • 29 Melissas J, Braghetto I, Molina JC , et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg 2015; 25 (12) 2430-2435
    CrossrefPubMedGoogle Scholar
  • 30 Stefater MA, Jenkins T, Inge TH. Bariatric surgery for adolescents. Pediatr Diabetes 2013; 14 (1) 1-12
    PubMedGoogle Scholar
  • 31 Sawhney P, Modi AC, Jenkins TM , et al. Predictors and outcomes of adolescent bariatric support group attendance. Surg Obes Relat Dis 2013; 9 (5) 773-779
    CrossrefPubMedGoogle Scholar
  • 32 Al-Sabah SK, Almazeedi SM, Dashti SA, Al-Mulla AY, Ali DA, Jumaa TH. The efficacy of laparoscopic sleeve gastrectomy in treating adolescent obesity. Obes Surg 2014; ;(October 2008): 50-54
    PubMedGoogle Scholar
  • 33 Boza C, Viscido G, Salinas J, Crovari F, Funke R, Perez G. Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients. Surg Obes Relat Dis 2012; 8 (2) 133-137 ; discussion 137–139
    CrossrefPubMedGoogle Scholar
  • 34 Cozacov Y, Roy M, Moon S , et al. Mid-term results of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in adolescent patients. Obes Surg 2014; 24 (5) 742-752
    PubMedGoogle Scholar
  • 35 Nocca D, Nedelcu M, Nedelcu A , et al. Laparoscopic sleeve gastrectomy for late adolescent population. Obes Surg 2014; 24 (6) 861-865
    CrossrefPubMedGoogle Scholar