Systematic review and meta-analysis of bariatric surgery for pediatric obesity

ECRI Institute, Evidence-Based Practice Center and Health Technology Assessment Information Service, Plymouth Meeting, Pennsylvania, 19462, USA.
Annals of surgery (Impact Factor: 7.19). 11/2008; 248(5):763-76. DOI: 10.1097/SLA.0b013e31818702f4
Source: PubMed

ABSTRACT The prevalence of morbid obesity has risen sharply in recent years, even among pediatric patients. Bariatric surgery is used increasingly in an effort to induce weight loss, improve medical comorbidities, enhance quality of life, and extend survival. We performed a systematic review and meta-analysis of all published evidence pertaining specifically to bariatric surgery in pediatric patients.
We systematically searched MEDLINE, EMBASE, 13 other databases, and article bibliographies to identify relevant evidence. Included studies must have reported outcome data for > or =3 patients aged < or =21, representing > or =50% of pediatric patients enrolled at that center. We only included English language articles on currently performed procedures when data were separated by procedure, and there was a minimum 1-year follow-up for weight and body mass index (BMI).
Eight studies of laparoscopic adjustable gastric banding (LAGB) reported data on 352 patients (mean BMI 45.8); 6 studies of Roux-en-Y gastric bypass (RYGB) included 131 patients (mean BMI 51.8); 5 studies of other surgical procedures included 158 patients (mean BMI 48.8). Average patient age was 16.8 years (range, 9-21). Meta-analyses of BMI reductions at longest follow-up indicated sustained and clinically significant BMI reductions for both LAGB and RYGB. Comorbidity resolution was sparsely reported, but surgery did appear to resolve some medical conditions including diabetes and hypertension. For LAGB, band slippage and micronutrient deficiency were the most frequently reported complications, with sporadic cases of band erosion, port/tube dysfunction, hiatal hernia, wound infection, and pouch dilation. For RYGB, more severe complications have been documented, such as pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, staple line leak, and severe malnutrition.
Bariatric surgery in pediatric patients results in sustained and clinically significant weight loss, but also has the potential for serious complications.

Download full-text


Available from: Jonathan R. Treadwell, Aug 19, 2015
  • Source
    • "adolescent as well as in the adult [7] [8] [9] [10] [11] [12]. Indeed, a recent meta-analysis found that in adolescents, bariatric surgery was associated with permanent weight loss and resolution of concomitant metabolic conditions, including diabetes and hypertension [11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obese adults are frequently vitamin D deficient before bariatric surgery; whether similar abnormalities exist in morbidly obese adolescents is unknown. To determine the prevalence of vitamin D deficiency in morbidly obese adolescents. Cross-sectional study of preoperative laboratory measures from 236 adolescents evaluated for bariatric surgery. The group (N = 219 with 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels; 76 boys, 143 girls; 15.9 ± 1.2 years; 43% Caucasian, 35% Hispanic, and 15% African American) had mean BMI of 47.6 ± 8.1 kg/m(2). 25OHD levels were deficient (<20 ng/mL) in 53%; 8% had severe deficiency (<10 ng/mL); only 18% of patients were replete (>30 ng/mL). 25OHD levels were inversely associated with BMI (r = -0.28, < 0.0001) and PTH levels (r = -0.24, P = 0.0003). Race was the strongest predictor of 25OHD (P < 0.002); 82% of African Americans, 59% of Hispanics, and 37% of Caucasians were deficient. African American race, BMI, and PTH explained 21% of the variance in 25OHD (P < 0.0001). Most adolescents presenting for bariatric surgery have suboptimal vitamin D levels, with African Americans and those with higher BMIs at greatest risk for vitamin D deficiency. All morbidly obese adolescents should be screened for vitamin D deficiency before bariatric procedures.
    02/2013; 2013. DOI:10.1155/2013/284516
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesitas is een toenemend probleem in de westerse wereld en komt ook bij kinderen steeds vaker voor. De voorkeursbehandeling van obesitas is gecombineerde leefstijlinterventie, maar dit geeft met name bij morbide obesitas vaak teleurstellende resultaten. Bariatrische (obesitas) chirurgie geeft bij morbide obese volwassenen een gewichtsreductie van ongeveer 30%, met vermindering van mortaliteit en morbiditeit en een betere kwaliteit van leven. De eerste resultaten van bariatrische chirurgie bij kinderen zijn hiermee vergelijkbaar. De rationale, methoden, potentiële voor- en nadelen van bariatrische chirurgie bij kinderen worden hier besproken. Obesity is an increasing problem in the Western world and its prevalence in children is also increasing. The treatment of choice of obesity is by combined lifestyle interventions, but the results are, particularly in morbid obesity, often disappointing. Bariatric (obesity) surgery in adults is an effective mode of treatment with an average weight loss of 30%, with reduction of mortality and morbidity and a better quality of life. The preliminary results of bariatric surgery in children are comparable. The rationale, methods, potential advantages and disadvantages of bariatric surgery in children are discussed.
    Tijdschrift voor kindergeneeskunde 78(3):114-119. DOI:10.1007/BF03089887
  • [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of overweight and obesity in minors increases rapidly. Also, the heaviest children show higher weights than before. Defining overweight and obesity in minors is more complicated than in adults, due to the influence of growth and puberty. A broad international consensus has been reached on BMI being the most optimal and simple standard for determining overweight and obesity. Established BMI reference values are available both on a Dutch and international scale. Children and adolescents suffer from obesity-related morbidities, which can be reduced by weight loss. Active intervention is required in obese minors as spontaneous regression does not usually occur. An obese minor is very likely to become an obese adult. As long as evidence based treatment options are unavailable, intervention in cases of severe obesity in minors will have to be based on best practices or best-practise-based guidelines. Obesity, and especially severe obesity, requires sufficiently prolonged treatment as do all chronic disorders. Cases of weight regain require repeated intensive treatment. Bariatric surgery is not yet an option in pediatric obesity treatment.
    Tijdschrift voor kindergeneeskunde 78(3):98-103. DOI:10.1007/BF03555576
Show more