In the Journals

Preferred method of bariatric surgery among teens is changing

More teenagers who are undergoing metabolic and bariatric surgery are opting for vertical sleeve gastrectomies over laparoscopic Roux-en-Y gastric bypass or adjustable gastric bands, according to research published in JAMA Pediatrics. This trend, according to researchers, mirrors trends seen in adults undergoing these procedures.

Cornelia L. Griggs, MD, a surgery resident at Massachusetts General Hospital, and colleagues wrote that severe pediatric obesity — defined as a BMI of at least 35 kg/m2 or at least 120% above the 95th percentile — affects more than 4.5 million American children and teenagers. The rate of severe pediatric obesity has risen from 4% in 2000 to 6% in 2016, with the researchers calling the increase “a national public health crisis.”

“For children and adolescents with this disease, metabolic and bariatric surgery (MBS) is effective in achieving long-term weight loss and resolution of comorbidities,” the researchers wrote.

Griggs and colleagues identified patients aged 20 years or younger who received MBS between January 2005 and December 2014. Surgeries that were not elective, including procedures for inflammatory bowel disease, colitis or gastrointestinal malignancy, were excluded from the study.

Approximately 14,178 MBSs were performed during the study in patients aged 20 years or younger. More than half of these patients (59.4%) were white, 15.4% were black and 17.5% were Hispanic. More than three-quarters of all patients were female (78.1%) and had an average age of 18.6 years.

The average length of stay associated with these procedures was 2 days. This number remained consistent throughout the study. Researchers observed that over time, complications related to MBS decreased significantly from 55.4% in 2005 to 27.7% in 2014, and no more than 10 in-hospital deaths occurred in 2006. No other deaths were reported.

Griggs and colleagues observed a 70.6% increase in vertical sleeve gastrectomies conducted during the study period, with 10 or fewer in 2005 to 1,225 in 2014. Laparoscopic Roux-en-Y gastric bypass procedures became less popular during the timeframe assessed (753 procedures in 2005 vs. 480 procedures in 2014). Although an increase in adjustable gastric bands was observed in 2009 (418 procedures), 10 or fewer were reported in 2014.

Few vertical banded gastroplasties and biliopancreatic diversion with a duodenal switch occurred during the 10-year study.

“The possible causes for the low rate of surgical management among this population are multifactorial and include a likely overestimation of the short- and long-term risks of MBS along with an under-recognition of the long-term detrimental consequences of pediatric obesity,” Griggs and colleagues wrote. “An additional factor that greatly hinders appropriate referral for surgical evaluation is an inadequate number of multidisciplinary programs willing to treat pediatric patients. In the end, a large population of pediatric patients with severe obesity are not referred to and/or do not have access to the best care for their disease, to include discussion of MBS.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

More teenagers who are undergoing metabolic and bariatric surgery are opting for vertical sleeve gastrectomies over laparoscopic Roux-en-Y gastric bypass or adjustable gastric bands, according to research published in JAMA Pediatrics. This trend, according to researchers, mirrors trends seen in adults undergoing these procedures.

Cornelia L. Griggs, MD, a surgery resident at Massachusetts General Hospital, and colleagues wrote that severe pediatric obesity — defined as a BMI of at least 35 kg/m2 or at least 120% above the 95th percentile — affects more than 4.5 million American children and teenagers. The rate of severe pediatric obesity has risen from 4% in 2000 to 6% in 2016, with the researchers calling the increase “a national public health crisis.”

“For children and adolescents with this disease, metabolic and bariatric surgery (MBS) is effective in achieving long-term weight loss and resolution of comorbidities,” the researchers wrote.

Griggs and colleagues identified patients aged 20 years or younger who received MBS between January 2005 and December 2014. Surgeries that were not elective, including procedures for inflammatory bowel disease, colitis or gastrointestinal malignancy, were excluded from the study.

Approximately 14,178 MBSs were performed during the study in patients aged 20 years or younger. More than half of these patients (59.4%) were white, 15.4% were black and 17.5% were Hispanic. More than three-quarters of all patients were female (78.1%) and had an average age of 18.6 years.

The average length of stay associated with these procedures was 2 days. This number remained consistent throughout the study. Researchers observed that over time, complications related to MBS decreased significantly from 55.4% in 2005 to 27.7% in 2014, and no more than 10 in-hospital deaths occurred in 2006. No other deaths were reported.

Griggs and colleagues observed a 70.6% increase in vertical sleeve gastrectomies conducted during the study period, with 10 or fewer in 2005 to 1,225 in 2014. Laparoscopic Roux-en-Y gastric bypass procedures became less popular during the timeframe assessed (753 procedures in 2005 vs. 480 procedures in 2014). Although an increase in adjustable gastric bands was observed in 2009 (418 procedures), 10 or fewer were reported in 2014.

Few vertical banded gastroplasties and biliopancreatic diversion with a duodenal switch occurred during the 10-year study.

“The possible causes for the low rate of surgical management among this population are multifactorial and include a likely overestimation of the short- and long-term risks of MBS along with an under-recognition of the long-term detrimental consequences of pediatric obesity,” Griggs and colleagues wrote. “An additional factor that greatly hinders appropriate referral for surgical evaluation is an inadequate number of multidisciplinary programs willing to treat pediatric patients. In the end, a large population of pediatric patients with severe obesity are not referred to and/or do not have access to the best care for their disease, to include discussion of MBS.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.