Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review

Abstract Introduction Bariatric surgery is performed at increasing rate in severely obese adolescents who do not respond to conservative treatment. In the United States, this treatment is generally accepted, yet in Europe, surgeons are more reluctant because of concerns regarding safety and (long-term) efficacy. We evaluated in which (European) countries bariatric surgery is allowed and performed, and the opinion of the members of the European Paediatric Surgeons' Association (EUPSA) regarding bariatric surgery in adolescents. Materials and Methods Information was obtained with an online questionnaire sent to all EUPSA members. Results A total of 108 pediatric surgeons (PSs) from 33 countries (of which 25 European) completed the survey. Sixty-two PSs (57.4%) from 22 countries stated that bariatric surgery in adolescents was allowed in their country. In only 14 countries, the costs were (partially) covered by health care insurances. Overall, 65.7% of the surgeons (n = 71) believed bariatric surgery may offer a valuable contribution to obtain substantial long-term weight loss in severely obese adolescents. Fifty-one (47.2%) reported that these procedures should be performed by a combination of a bariatric and a PS, while 20 (18.5%) and 16 (14.8%) preferred that these procedures should be performed solely by a PS or bariatric surgeon, respectively. Conclusion Although allowed in most European countries, bariatric surgery in adolescents is only practiced on a small scale, and the treatment is often excluded from regular health care reimbursement. The majority of PSs acknowledge the value of bariatric surgery, which should be performed by a combination of PS and bariatric surgeon.

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Severely Obese Adolescents Benefit From Bariatric Surgery

Internal Medicine News ◽

10.1016/s1097-8690(09)70579-7 ◽

2009 ◽

Vol 42 (15) ◽

pp. 22

Author(s):

DAMIAN MCNAMARA

Keyword(s):

Bariatric Surgery ◽

Obese Adolescents ◽

Severely Obese

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Bariatric Surgery As a Treatment Option for Severely Obese Adolescents

PsycEXTRA Dataset ◽

10.1037/e620402013-001 ◽

2013 ◽

Author(s):

Anna Maria Patino-Fernandez ◽

Rachel L. Manes

Keyword(s):

Bariatric Surgery ◽

Treatment Option ◽

Obese Adolescents ◽

Severely Obese

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Short and Long Term Clinical Safety and Efficacy of Endeavor Stents in Primary Percutaneous Coronary Intervention

Heart Lung and Circulation ◽

10.1016/j.hlc.2010.06.1025 ◽

2010 ◽

Vol 19 ◽

pp. S151

Author(s):

W. Ahmar ◽

Y. Malaiapan ◽

T. Katticaran ◽

P. See ◽

I. Meredith

Keyword(s):

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Clinical Safety ◽

Safety And Efficacy ◽

Percutaneous Coronary ◽

Short And Long Term

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Bariatric surgery in severely obese adolescents: a single-centre experience

Archives of Disease in Childhood ◽

10.1136/archdischild-2013-305583 ◽

2014 ◽

Vol 99 (10) ◽

pp. 894-898 ◽

Cited By ~ 13

Author(s):

P. Sachdev ◽

T. Makaya ◽

S. S. Marven ◽

R. Ackroyd ◽

J. K. Wales ◽

...

Keyword(s):

Bariatric Surgery ◽

Single Centre ◽

Obese Adolescents ◽

Single Centre Experience ◽

Severely Obese

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Bariatric Surgery Is Protective Against Renal Function Decline in Severely Obese Patients in the Long-Term

Obesity Surgery ◽

10.1007/s11695-020-05096-w ◽

2020 ◽

Author(s):

Anne Lautenbach ◽

Jan-Wilhelm Wienecke ◽

Fabian Stoll ◽

Nina Riedel ◽

Oliver Mann ◽

...

Keyword(s):

Bariatric Surgery ◽

Renal Function ◽

Negative Correlation ◽

Filtration Rate ◽

Obese Patients ◽

Renal Function Decline ◽

Severely Obese ◽

Age And Sex

Abstract Purpose This study aims to assess the long-term renal effects of bariatric surgery (BS) in severely obese patients over a follow-up period of up to 11 years. Materials and Methods In a retrospective cohort study including 102 patients, patients were stratified by eGFR at baseline and divided into three groups: (1) reduced, (2) normal, and (3) increased filtration rate. Adjustments for age- and sex-related decline in eGFR were performed. We used uni- and multivariate regression analysis to identify variables that were thought to determine change in eGFR. Results Over a median follow-up of 8.5 years (interquartile range 2.7), eGFR declined from 96.1 ± 20.7 to 84.9 ± 21.0 ml/min (p < 0.001). Among patients with (1), eGFR remained stable (69.1 ± 19.3 ml/min). Among patients with (2), eGFR declined from 99.7 ± 13.3 ml/min to 88.7 ± 19.4 ml/min (p < 0.001). Among patients with (3), eGFR decreased to normal levels (94.2 ± 17.7 ml/min, p < 0.001). Age- and sex-adjusted eGFR increased (6.4 ± 14.4 ml/min; p < 0.05) among patients with reduced filtration rate. Among patients with normal filtration rate, adjusted eGFR remained stable during follow-up (−1.3 ± 15.2 ml/min; n.s.). Among patients with increased filtration rate, adjusted eGFR decreased and remained within the normal range (−13.2 ± 12.2 ml/min; p < 0.001). Change in eGFR showed a negative correlation with eGFR at baseline (B = −0.31; p < 0.001), change in LDL-cholesterol (B = -0.09; p < 0.05), and a negative correlation with treatment requiring hypertension (B = -9.36; p = 0.001). Conclusion BS is protective against renal function decline in severely obese patients in the long term.

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Bariatric surgery in patients with type 1 diabetes: special considerations are warranted

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818822207 ◽

2019 ◽

Vol 10 ◽

pp. 204201881882220 ◽

Cited By ~ 5

Author(s):

Zohar Landau ◽

Galit Kowen-Sandbank ◽

Daniela Jakubowicz ◽

Asnat Raziel ◽

Nasser Sakran ◽

...

Keyword(s):

Bariatric Surgery ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Glucose Control ◽

Healthcare Services ◽

Short And Long Term ◽

The Mean

Objective: We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM). Methods: We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years. Results: Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 ( p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 ( p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% ( p = 0.09). Conclusions: Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.

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