Abstract
Background
Adolescent obesity is considered a public health challenge. Sleeve gastrectomy (SG) may be considered a safe option for treatment of adolescent obesity. This study aimed to assess the outcomes of SG in treatment of severe obesity in adolescents, with emphasis on the impact of baseline body mass index (BMI) and adherence to follow-up.
Methods
This was a single-center retrospective cohort study on adolescents with severe obesity who underwent SG at a tertiary referral bariatric center. The main outcome measures were weight loss, improvement in comorbidities at 12 months postoperatively, and complications.
Results
A total of 72 adolescent patients (47 female) of a mean BMI of 47.9 ± 7.1 kg/푚2 were enrolled in the study. The mean %TWL was 34.94 ± 9.35 and the mean %EWL was 73.47 ± 22.12. Complete remission was recorded in all patients with type 2 diabetes mellitus (DM), pre-DM, and sleep apnea, in 80% of patients with hypertension, and 57% of patients with hypothyroidism. The long-term complication rate after SG was 18%. Patients with higher preoperative BMI had significantly (p = 0.018) lower %EWL at 1 year.
Conclusion
SG is an effective and safe surgical procedure for adolescents with severe obesity. It was associated with a significant weight loss, high comorbidity remission rates, and no mortality or serious complications. Lower baseline BMI and better adherence to follow-up were associated with better outcome of SG.
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References
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020.
Radwan H, Ballout RA, Hasan H, et al. The epidemiology and economic burden of obesity and related cardiometabolic disorders in the United Arab Emirates: a systematic review and qualitative synthesis. J Obes. 2018;2018:2185942–23. https://doi.org/10.1155/2018/2185942.
Al-haddad FH, Little BB, Abdul Ghafoor AG. Childhood obesity in United Arab Emirates schoolchildren: a national study. Ann Hum Biol. 2005;32(1):72–9. https://doi.org/10.1080/03014460400027425.
Bin Zaal A, Brebner J, Musaiger A, et al. Anthropometric characteristics and obesity among adolescents in the United Arab Emirates. East Mediterr Health J. 2011;17(05):382–6. https://doi.org/10.26719/2011.17.5.382.
Must A, Jacques PF, Dallal GE, et al. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard growth study of 1922 to 1935. N Engl J Med. 1992;327:1350–5.
UnitedHealth Group. (2010). Diabetes in the United Arab Emirates: crisis or opportunity? https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2010/UNH_WorkingPaperDiabetesUAE.pdf
Zeller M, Kirk S, Claytor R, et al. Predictors of attrition from a pediatric weight management program. J Pediatr. 2004;144:466–70.
Childhood and adolescent obesity. American Society for Metabolic and Bariatric Surgery. https://asmbs.org/patients/adolescent-obesity
Panagiotis L, Gianpaolo D, Giuseppe D, et al. Laparoscopic sleeve gastrectomy for adolescents under 18 years old with severe. Obes Surg. 2020;30:267–73.
Hsia DS, Fallon SC, Brandt ML. Adolescent bariatric surgery. Arch Pediatr Adolesc Med. 2012;166(8):757–66. https://doi.org/10.1001/archpediatrics.2012.1011.
Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–20. discussion 420-412.
Biter L, Grotenhuis B, Zengerink J, et al. Laparoscopic sleeve gastrectomy versus gastric bypass in late adolescents: what is the optimal surgical strategy for morbid obesity? Eur J Pediatr Surg. 2016;26(06):487–93. https://doi.org/10.1055/s-0035-1570104.
World Health Organization. The global strategy for women’s, children’s and adolescents’ health (2016-2030). https://www.who.int/life-course/partners/global-strategy/ewec-globalstrategyreport-200915.pdf?ua=1.
Sawyer SM, Azzopardi PS, Wickremarathne D, et al. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8. https://doi.org/10.1016/S2352-4642(18)30022-1.
Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123(15):1683–701.
ICD-10-CM section T80-T88. ICD. Codes - your free medical coding resource. https://icd.codes/icd10cm/chapter19/T80-T88
Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25(4):587–606. https://doi.org/10.1007/s11695-015-1645-3.
Reinhold RB. Critical analysis of long term weight loss following gastric bypass. SurgGynecolObstet. 1982;155(3):385–94.
Al-Sabah SK, Almazeedi SM, Dashti SA, et al. The efficacy of laparoscopic sleeve gastrectomy in treating adolescent obesity. Obes Surg. 2015;25(1):50–4. https://doi.org/10.1007/s11695-014-1340-9.
El-Matbouly MA, Khidir N, Touny HA, et al. A 5-year follow-up study of laparoscopic sleeve gastrectomy among morbidly obese adolescents: does it improve body image and prevent and treat diabetes? Obes Surg. 2018;28(2):513–9. https://doi.org/10.1007/s11695-017-2884-2.
Alqahtani AR, Antonisamy B, Alamri H, et al. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg. 2012;256(2):266–73. https://doi.org/10.1097/SLA.0b013e318251e92b.
Aridi HD, Fawal H, Shaghoury I, et al. Efficacy and safety of laparoscopic sleeve gastrectomy in adolescents. Bariatric Surg Pract Patient Care. 2016;11(2):78–83. https://doi.org/10.1089/bari.2015.0051.
Nadler EP, Barefoot LC, Qureshi FG. Early results after laparoscopic sleeve gastrectomy in adolescents with morbid obesity. Surgery. 2012;152(2):212–7. https://doi.org/10.1016/j.surg.2012.05.010.
Pourcher G, De Filippo G, Ferretti S, et al. Short-term results of single-port sleeve gastrectomy in adolescents with severe obesity. Surg Obes Relat Dis. 2015;11(1):65–9. https://doi.org/10.1016/j.soard.2014.05.029.
Nocca D, Nedelcu M, Nedelcu A, et al. Laparoscopic sleeve gastrectomy for late adolescent population. Obes Surg. 2014;24(6):861–5. https://doi.org/10.1007/s11695-014-1200-7.
Elbanna H, Ghnnam W, Negm A, et al. Impact of preoperative body mass index on the final outcome after laparoscopic sleeve gastrectomy for morbid obesity. Ulusalcerrahidergisi. 2016;32(4):238–43. https://doi.org/10.5152/UCD.2016.3275.
Ochner CN, Jochner MCE, Caruso EA, et al. Effect of preoperative body mass index on weight loss after obesity surgery. Surg Obes Relat Dis. 2013;9(3):423–7. https://doi.org/10.1016/j.soard.2012.12.009.
Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70–89. https://doi.org/10.1007/s11695-011-0472-4.
Vuolo G, Voglino C, Tirone A, et al. Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg. 2016;30:48–55. https://doi.org/10.1016/j.ijsu.2016.04.026.
Sharma V, Coleman S, Nixon J, et al. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev. 2019;20(10):1341–9. https://doi.org/10.1111/obr.12904.
Pham S, Gancel A, Scotte A, et al. Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study. J Obes. 2014;638203. https://doi.org/10.1155/2014/638203.
Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83. https://doi.org/10.1016/j.soard.2013.11.007.
Bobowicz M, Lehmann A, Orlowski M, et al. Preliminary outcomes 1 year after laparoscopic sleeve gastrectomy based on bariatric analysis and reporting outcome system (BAROS). Obes Surg. 2011;21:1843–8. https://doi.org/10.1007/s11695-011-0403-4.
Inge T, Courcoulas A, Jenkins T, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(20):1988–90. https://doi.org/10.1056/nejmc1602007.
Inge TH, Jenkins TM, Xanthakos SA, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5(3):165–73. https://doi.org/10.1016/s2213-8587(16)30315-1.
Abdallah E, Emile SH, Elfeki H, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017;47(7):844–50. https://doi.org/10.1007/s00595-016-1446-x.
Medina ARS, Walston M, Xu J, et al. Characteristics of weight regain following sleeve gastrectomy in an adolescent bariatric program. Surg Obes Relat Dis. 2017;13(10):S70. https://doi.org/10.1016/j.soard.2017.09.154.
Coupaye M, Rivière P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24(2):276–83. https://doi.org/10.1007/s11695-013-1089-6.
Ruiz-Tovar J, Oller I, Llavero C, et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg. 2014;80(5):466–71.
Acknowledgments
We would like to express our great appreciation and thanks to the General Surgery team, Operation Theatre staff, and the Surgical Wards’ staff in Al-Qassimi Hospital for their hard work, constant support, and encouragement.
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Mohammed, M.R., Mahdy, T., Hashem, A. et al. Impact of Baseline BMI and Adherence to Follow-Up on the Outcome of Sleeve Gastrectomy in Treatment of Adolescent Obesity. OBES SURG 31, 2567–2575 (2021). https://doi.org/10.1007/s11695-021-05285-1
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DOI: https://doi.org/10.1007/s11695-021-05285-1