, et al
A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes
J Pediatr Surg
; doi: jpedsurg.2009.10.013

Investigators at the University of Illinois-Chicago and Rush University reported their 12-month outcomes using adjustable laparoscopic gastric banding (LAGB) in the treatment of 20 morbidly obese adolescents. All subjects were participants in a multidisciplinary treatment program. Comorbidities were monitored using standardized criteria. Quality of life (QOL) was assessed using validated survey tools.

A total of 26 consecutive patients were enrolled between 2005 and 2007. Data were analyzed for 20 patients who completed at least 12 months of follow-up, 12 of whom completed 18 months of follow-up in this ongoing study. The mean age of study patients at entry was 16 years, with a 1:3 male-to-female ratio. Mean BMI was 50 kg/m2; 35% of the participants had a BMI >50 kg/m2. The mean weight of the patients at study entry was 296 lb with an average excess weight above ideal weight of 178 lb. Comorbidities included metabolic syndrome (95%), insulin resistance (90%), biopsy-proven non-alcoholic steatohepatitis (88%), dyslipidemia (80%), and hypertension (60%). Health-impaired patient-described QOL was reported in 75%.

Mean percentages of excess weight loss at 6, 12, and 18 months were 26%, 34%, and 41%, respectively. Hypertension resolved in all patients by 12 months. Metabolic syndrome resolved in 63% of patients at 12 months and in 82% at 18 months of follow-up. Insulin resistance resolved in 45% of affected participants (12 months) and 72% (18 months), and dyslipidemia in 44% (12 months) and 67% (18 months). QOL measurements were significantly higher than at baseline at both 12 and 18 months. At last follow-up, one third of adolescents had QOL scores within the normal range. There were five patients with less than 20% excess weight loss at 12 months. Despite this limited weight loss, two of these five adolescents had resolution of their dyslipidemia and metabolic syndrome.

Complications were uncommon, with three late wound explorations for tube or port problems and two late laparoscopic re-operations (one for hiatal hernia and one for band malfunction). There were no deaths.

The authors conclude that LAGB is a valuable surgical adjunct to a comprehensive weight loss program, with clinically significant weight loss and resolution or improvement of metabolic and psychosocial comorbidities in most adolescents.

The management of morbid obesity in adolescents is controversial. The lack of long-term success with dietary interventions has led to an interest in surgical approaches that have a proven track record in morbidly obese adults. The most commonly performed obesity surgery in US adults is laparoscopic Roux-en-Y gastric bypass;1 however, the reversible and adjustable nature of LAGB and the decreased incidence and severity of complications make it the current procedure of choice in adolescents.2 

Several reports have documented the success of...

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