Obesity Surgery
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Transcript Obesity Surgery
Bariatric Surgery: A Major
Decision for Minors
ALEX KLOEHN, CAMI MANDELL
http://www.cdc.gov/nchs/data/hestat/obesity_child_09_10/obesity_child_09_10.htm
Childhood and Adolescent Obesity Statistics
Obesity rates in children age 6-11 increased from 7% to 18% between
1980 and 2010 in the US (Ogden, 2012)
Obesity rates in adolescents age 12-19 increased from 5% to 18.4%
between 1980 and 2010 in the US (Ogden, 2012)
http://arch1design.com/blog/latest_environmental_health_news/childhood-obesity-prevalence-and-prevention/
Concerns of Childhood Obesity
Obese adolescents are
likely to be obese as adults
(Freedman, 2005)
Increased risk of depressive
symptoms and lower
quality of life scores.
(Schwimmer, 2003)
Increased risk of
Hypertension
Hypercholesterolemia
Hypertriglyceridemia
Hyperinsulinemia
Atherosclerosis
Metabolic syndrome
Obstructive sleep apnea
PCOS
Non-alcoholic fatty liver disease
Certain cancers
(Flynn, 2006)
Brief History of Bariatric Surgery
1952- First recorded operation to
cure obesity was performed by
Viktor Henrikson as a small bowel
resection
Shortly followed by jejunocolic
bypasses that led to loss of fluid,
electrolytes, and led to liver failure.
(On left)
Mid 1950’s - Jejunoileal Bypass
came next and remained popular
through the 1970’s
(Deitel, 2012)
Brief History of Bariatric Surgery (Cont’d)
1960’s - Gastric
Bypass was first
developed
1970’s - Roux-enY GB was
developed and has
been modified
several times since.
(Deitel, 2012)
Brief History of Bariatric Surgery (Cont’d)
1970’s -
Biliopancreatic
Diversion and
Duodenal Switch were
also introduced to
address concerns over
Blind Loop Syndrome.
1980’s – Adjustable
gastric banding
procedures were
popularized
(Deitel, 2012)
Brief History of Bariatric Surgery (Cont’d)
2000’s – The first
sleeve gastrectomy
procedures were
recorded.
(Deitel, 2012)
Common Types of BS Performed Today
http://www.hormone.org/questions-and-answers/2012/bariatric-surgery
Adolescent Bariatric Surgery (ABS) Statistics
US Nationwide Inpatient Sample: 2,744 ABS
procedures were performed in the US between 1996
and 2003. (Black, 2013)
Healthcare Cost and Utilization Project Kids’
Inpatient Database (KID), 1009 ABS procedures
were performed in 2009. (Kelleher, 2013)
Trends towards minimally invasive procedures
Plateau of ABS procedures since 2003.
Trends in Surgery Performed 2000-20009
1200
1000
800
Ages 10 - 17
600
Ages 18 - 19
total
400
200
0
2000
Adapted from data in Kelleher, 2013
2003
2006
2009
Physical & Psychological Benefits
BMI reduction
Wide range, depending on study follow-up
length
Most occurs in first year
Some alleviation of comorbid
conditions
Most occurs in first year
Hard to accurately assess due to follow-up loss
Increased in quality of life
Pre-operative scores similar to children with
cancer (Loux, 2008)
Significantly increased scores post-operatively
(Loux, 2008)
BMI Reduction
Very little long-term follow-up data
Wide range of results
RYGB, 12 month follow-up (Lawson, 2006)
Pre-op 56.5±10.1
Post-op 35.8±6.9
RYGB, 17.1±12.3 month follow-up (Loux, 2008)
Pre-op 54.1±7.6
Post-op 35.1±9.3
LSG, 12 month follow-up (Nadler, 2012)
Pre-op 52±9,
Post-op 39±8
RYGB, 24 month follow-up (Teeple, 2012)
Pre-op 58.8±10.7,
Post-op mean 34.9±5.6
Co-morbid Conditions
Most common pre-operative:
Impaired glucose tolerance
Insulin resistance
Hypertension
Sleep apnea
Dyslipidemia
Fatty liver disease
Post-operative results
Improvement in glucose
tolerance and insulin
resistance
Resolution of dyslipidemia
Resolution of sleep apnea
Decrease in blood pressure
(Teeple, 2012; Nadler, 2012, Lennerz, 2013, Lawson, 2006, Loux, 2008)
Risks and Complications of Surgery
Complications are similar to adults (Inge, 2013)
Late weight regain (up to 20%) (Xanthakos, 2008)
Recurrence of depression and eating disturbances that affect
QOL (Pratt, 2009)
Marginal ulcers, small bowel obstruction, protein and
micronutrient deficiencies
Gastric band slippage
Pregnancy
Risks and Complications of Surgery (Cont’d)
May cause problems with proper growth if children
are not done growing (Barnett, 2013)
Low adherence to follow-up (Lennerz, 2013)
Best Practice Eligibility Criteria
BMI
>35 with severe comorbidities
>40 with any comorbities
Physiological Maturity
Height ~ 95% adult height based on estimate of bone age
Pubertal Maturity based on Tanner Stages (IV+)
Girls usually ≥13; Boys usually ≥15
Lifestyle Change
Demonstrate ability to make sustained dietary and physical
activity changes
(Pratt, 2009)
Best Practice Eligibility Requirements
Psychosocial Maturity
Appropriate decision making
skills and understanding of
risks and benefits
Social support network
Psychiatric conditions
managed under treatment
Evidence of patient/family
ability to comply with
treatment plan pre- and postsurgery
(Pratt, 2009)
Future Directions
Necessity of long-term data on physical and
psychological outcomes
Options of minimally invasive surgeries (Shebrain, 2013)
Need to address possibility of weight regain
Rethink criteria using BMI for weight loss surgery to
catch adolescents before they become
severely/morbidly obese
Assert that surgeons performing surgery are
qualified to do so with the special considerations of
adolescents
Questions?
References
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