Background: Because the success rate of lifestyle interventions is modest in severely obese adolescents, surgical treatments are now proposed. Laparoscopic adjustable gastric banding (LAGB) represents an attractive treatment with minimal morbidity and reversible procedure.
Method: All adolescents were included in prospective longitudinal assessment and entirely managed by a pediatric team. Surgery was proposed only after at least 1-year lifestyle intervention in a multidisciplinary program. 3 years after surgery, an adult transition plan has been implemented.
Results: Since 2008, 44 adolescents have undergone LAGB. The mean age and mean BMI at surgery was 16.6±0.9 years and 45.1±5.2 kg/m2, corresponding to a mean weight of 127.6±19.8 kg. Base line comorbidities data demonstrated a high incidence of insulin resistance (IR), and 75% of metabolic syndrome. An average of 12 visits in the first year, nine in the second and five in the 3rd year were recorded. 52% of patients had more than 3 years of follow-up (median 28, range 384 months). 3 years after surgery median weight loss was 41 kg (257) corresponding to a percentage of excess weight lost of 77% (3100), the majority of weight loss was evident after the 1st year. Mean BMI tends to stabilize after the second year (33.3±6.6 vs 32.8±8.2 at 2 and 3 years respectively, P=ns). An improvement in metabolic status was demonstrated (HOMA-IR decreased from 5.5±3.3 to 1.4±1.1, P<0.005). In multivariate analysis only the mean number of consultations/year, was found significant on weight loss, significant differences were found between patients who had 6 or less consultations/year and those with 12 consultations/year for final weight (P=0.004) or EWL (P=0.005).
Conclusion: Among severe obese adolescents there was substantial weight loss and an improvement of metabolic profile 3 years after LAGB. But these require a high degree of patient cooperation and professional support. However this technique appears to be a primary choice for bariatric surgical procedure. Long-term outcomes are still lacking.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology