Bariatric Surgery in Adolescents and Young Adults

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 695-707-Obesity Treatment
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-698
Belinda S Lennerz*1, Christine Stroh2, Hans Lippert3, Stefanie Wolff3, Christian Knoll4, Rudolf Weiner5, Thomas Manger6 and Martin Wabitsch1
1University of Ulm, Ulm, Germany, 2Waldklinikum Gera, Gera, 3Otto von Guericke University, Magdeburg, 4Statconsult Magdeburg, Gesellschaft für klinische und Versorgungsforschung mbh, Magdeburg, 5Hospital Frankfurt Sachsenhausen, Sachsenhausen, 6Wald-Klinikum Gera, Gera
Background: To date, the only effective treatment to achieve sustained weight loss and reverse co morbidities in adults with morbid obesity is bariatric surgery. Of note, the effects of bariatric surgery are beyond the mechanical / absorptive aspects, and endocrine effects precede weight loss. While adolescents have specific implications that may shift the risk benefit ratio, the use of surgical weight loss therapy in this age group is increasing worldwide. The aim of this study was to determine the safety and efficacy of adolescent bariatric surgery.
Methods: Since January 2005, patients undergoing bariatric surgery in Germany are captured in a registry in the context of the ongoing „study for quality assurance in obesity surgeries“. Here, we conducted a descriptive analysis including all patients who were under the age of 22 years and had a primary surgical procedure from Jan 2005 to Dec 2010.
Results: A total of 345 procedures were recorded by 58 different hospitals. N=51 patients were under the age of 18 yrs. The most commonly applied surgical techniques were gastric banding (n=118, 34%), gastric bypass (n=116, 34%), and sleeve gastrectomy (n=78, 23%). Short-term complications are classified as intra-operative, general postoperative and specific postoperative. Rates of these complications were slightly lower in gastric banding (0.8%; 2.5%; 0.8%) compared to gastric bypass (2.6%; 5.2%; 1.7%) or sleeve gastrectomy (0%; 9.0%; 7.7%). Follow-up information is recorded for 48% (n=167) of patients, and the average duration of follow up was 544 days. In analogy to published findings, weight- and BMI reduction were lower in patients undergoing gastric banding (-28kg; -9.5kg/m2) compared to patients undergoing gastric bypass (-50kg; -16.4kg/m2) or sleeve gastrectomy (-46kg; -15.4kg/m2). Among the patients with follow up (n=167), IDDM rates decreased from 3% to 1.8% (40% reduction), NIDDM rates decreased from 6.6% to 2.4% (64% reduction), hypertension rates decreased from 32.9 to 16.8% (49% reduction), and sleep apnea rates decreased from 7.2 % to 4.2% (42% reduction).
Conclusion: Like in adults, bariatric surgery in adolescents results in significant and sustained weight loss and resolution of co morbidities. However, the low follow up rates and missing long-term observations prohibit a final conclusion about endocrine squeal and long-term efficacy and safety of adolescent bariatric surgery. Clinical trials with structured surgical programs and mechanisms to ascertain patient adherence are needed to derive at a final conclusion.

Nothing to Disclose: BSL, CS, HL, SW, CK, RW, TM, MW

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: This research was funded by the Federal Ministry for Education and Research (BMBF,  01GI1120A) and is integrated in the Competence Network Obesity (CNO).