“This NIH-funded study is benchmark research in the field of adolescent bariatric surgery," said coauthor Marc Michalsky, MD, Surgical Director of the Center for Healthy Weight and Nutrition at Nationwide Children's and a faculty member of The Ohio State University College of Medicine, Columbus, Ohio. “Participating in a study of this magnitude with colleagues around the country, collaborating to gather integral safety data, is both gratifying and hugely beneficial to adolescents suffering with severe obesity and health complications we used to diagnose only in adults. While the research continues, these initial findings should provide encouragement to adolescents and their families as they consider bariatric surgery," Dr. Michalsky said.
“The study confirms what is already well-documented in adults—bariatric surgery is relatively safe,” commented Daniel DeUgarte, MD, Associate Professor of Surgery, David Geffen School of Medicine at UCLA. “As reported in other large series of adolescent bariatric surgery, there have been no deaths. The adolescents in the study not only had an extremely elevated body mass index, they had already developed comorbidities seen in morbidly obese adults. Not surprisingly, the surgical complication rates were similar to those seen in adults,” Dr. DeUgarte said.
Prospective Observational Study Design
The prospective observational study—known as the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study—included 242 teens (average age, 17 years) with a median body mass index of 50.5. Approximately, half of these teenagers had four or more major comorbidities, most commonly dyslipidemia, sleep apnea, back and joint pain, hypertension, and fatty liver disease.
The teenagers had bariatric surgery between 2007 and 2012. Most (66%) had laparoscopic gastric bypass surgery, 28% had laparoscopic sleeve gastrectomy, and 6% had adjustable gastric banding. The primary outcome was complications within 30 days of the procedure.
Few Major Complications Found
Nineteen patients (8%) had major complications, including need for reoperation, postoperative bleeding requiring transfusion, deep venous thrombosis, pulmonary embolus, and intraoperative splenic injury requiring splenectomy. Thirty-six patients (15%) had minor complications, including readmission for abdominal complaints and dehydration, urinary tract events, gastrojejunal anastomotic stricture, and wound infection. No deaths occurred following surgery.
Clinical Implications of the Findings
“This is important news for families considering bariatric surgery for severely obese teens,” said lead author Dr. Inge, Surgical Director of the Surgical Weight Loss Program for Teens and Director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center in Ohio. “Parents who are considering weight loss surgery for their sons and daughters worry about complications and ask a lot about the safety of surgery—this study should help to alleviate or at least bring those concerns into context.”
“The study does not report on outcomes, but the efficacy of bariatric surgery compared to the alternative of medical therapy is well known, and we can assume that the short-term and long-term results will be published in due time,” Dr. DeUgarte commented. “The authors did report on complication rates for three different surgical procedures. Sleeve gastrectomy, which gained favor over the course of the study, appeared to have a lower complication rate than gastric bypass. In the future, comparison of the outcomes for the different procedures will help adolescents contemplating weight-loss surgery decide on the optimal approach,” Dr. DeUgarte told EndocrineWeb.
Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: The Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA Pediatr. 2014;168(1):47-53.