Background: Laparoscopic sleeve gastrectomy (LSG) has been established as a safe and effective bariatric procedure during adolescence, but its long-term results remain uncertain. Our aim was to report and compare the short- and long-term outcomes of LSG in adolescents.
Methods: We performed a retrospective analysis of patients submitted to LSG between 2010 and 2013 in our Institution. Baseline, short-term (1 year) and long-term (5-7 years) outcomes were evaluated. Outcomes included body mass index (BMI), percentage of excess weight loss (%EWL), surgical and clinical complications and co-morbidities resolution. Co-morbidities were classified as insulin resistance (HOMA-IR=2.5), dyslipidemia (TC>200 or LDL-C>130 or HDL-C<40 for boys and HDL-C<45 for girls or TG>130 mg/dL), hypertension (systolic blood pressure > 130 mmHg or diastolic blood pressure > 80 mmHg) and hepatic steatosis (positive abdominal ultrasound). Surgical successwas defined as %EWL >50%.
Results: A total of 11 patients were included (81.8% girls). Pre-operative mean age was 16.4 ±1.4 years and mean BMI was 46.0±5.0 kg/m2. At short-term follow-up, mean BMI and %EWL were 32.9 ±3.6 kg/m2 and 63.5%, respectively, with a success rate of 90.9%. Median long-term follow-up was 6.0 (4.8-6.9) years. At the long-term follow-up, mean BMI and %EWL were 42.9 ± 9.0 kg/m2and 28.3%, respectively, with a success rate of 27.2%. The mean %EWL were significantly different between the short and the long-term follow-up (63.5% x 28.3%; P<0.05). No patient presented with diabetes at baseline. Hypertension, dyslipidemia, insulin resistance and hepatic steatosis were diagnosed in 63.6%, 90.9%, 90.9% and 36.4% patients at baseline. This prevalence decreased to 9%, 9%, 36.4% and 0% at short-term follow-up, but increased up to 45.4%, 54.5%, 72.7% and 18.1% at long-term follow-up. There were no intra or postoperative complications, but a total of 63.6% of patients underwent laparoscopic cholecystectomy and about half of the girls presented with anemia (hemoglobin <12 g/dL) within 5 years.
Conclusions: Adolescents who underwent LSG had a high success rate, and showed both weight and metabolic improvements, in the short-term. Nevertheless, although some adolescents were able to retain metabolic improvements, the long-term outcomes showed that they regained weight and reacquired cardiometabolic risk factors, implicating in a lower success rate. We also showed an increased risk of cholecystectomy and anemia among girls. Further studies should focus on identifying the subgroup of patients to whom LSG is highly successful in the long term.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology