Current Opinions and Practices of Bariatric Surgery in Adolescents: A Survey among Pediatric Surgeons

2020 ◽  
Vol 30 (01) ◽  
pp. 117-121
Author(s):  
Yvonne G. M. Roebroek ◽  
Suzanne R. Pruijssers ◽  
Nicole D. Bouvy ◽  
Ernest L. W. E. van Heurn
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
The United States ◽  
European Countries ◽  
Small Scale ◽  
Online Questionnaire ◽  
Bariatric Surgeon ◽  
Obese Adolescents ◽  
Severely Obese

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.

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

2019 ◽  
Vol 87 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Lauren A. Sarno ◽  
Steven E. Lipshultz ◽  
Carroll Harmon ◽  
Nestor F. De La Cruz-Munoz ◽  
Preetha L. Balakrishnan
Keyword(s):  
Bariatric Surgery ◽  
Narrative Review ◽  
Safety And Efficacy ◽  
Obese Adolescents ◽  
Severely Obese ◽  
Short And Long Term

scholarly journals Bariatric Surgery: Risks and Rewards

2008 ◽  
Vol 93 (11_supplement_1) ◽  
pp. s89-s96 ◽  
Author(s):  
Walter J. Pories
Keyword(s):  
Bariatric Surgery ◽  
Severe Obesity ◽  
Pseudotumor Cerebri ◽  
The United States ◽  
Complication Rates ◽  
Centers Of Excellence ◽  
Ample Evidence ◽  
Severely Obese

ABSTRACT Context Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis. Objective: Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations. Interventions: Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. Positions: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United States—similar to the complication rates after cholecystectomy. Conclusions Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

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

2014 ◽  
Vol 99 (10) ◽  
pp. 894-898 ◽  
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

Women and the Invention of Well Child Care

PEDIATRICS ◽  
1994 ◽  
Vol 94 (4) ◽  
pp. 527-531
Author(s):  
Jeffrey P. Baker
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
The United States ◽  
European Countries ◽  
Office Visits ◽  
Separate Spheres ◽  
Well Child Care ◽  
American Academy Of Pediatrics ◽  
Therapeutic Services

Few rituals better capture the preventive ethos of pediatrics than does the well child examination. In the United States, 25 to 50% of all general pediatric office visits involve the supervision of routine health care. Yet the same cannot be said for many European countries. In Britain, pediatricians function primarily as hospital-based specialists, with general practitioners and public health nurses providing most preventive care and immunizations. Indeed, an American Academy of Pediatrics (AAP) study of several European countries and Canada in 1990 noted that only a minority of the nations surveyed relied principally on pediatricians for primary care. In the European paradigm, preventive and therapeutic services are frequently administered in separate spheres.

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

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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