Source:

Inge
TH
,
Zeller
MH
,
Jenkins
TM
, et al
.
Perioperative outcomes of adolescents undergoing bariatric surgery: the teen-longitudinal assessment of bariatric surgery (Teen-LABS) study
.
JAMA Pediatr
.
2014
;
168
(
1
):
47
53
; doi:
https://doi.org/10.1001/jamapediatrics.2013.4296

Investigators from multiple institutions prospectively enrolled a consecutive sample of patients <19 years old undergoing weight loss surgery (WLS) at one of 5 US academic referral centers. Although data collection was standardized, medical and surgical procedures varied across institutions. Preoperatively, investigators collected demographic and clinical data, including BMI, comorbid conditions, and laboratory measures relevant to cardiovascular risk and general health status. Investigators also collected data regarding the type of WLS performed and the occurrence of perioperative (time of surgery to hospital discharge) and postoperative (time of discharge to 30 days postdischarge) complications. The major goals of this study were to evaluate the clinical characteristics of adolescents undergoing WLS and to assess the short-term safety of the procedure in this population by measuring major perioperative and postoperative complications. A major perioperative complication was defined as an adverse event that was life-threatening or resulted in death, had potential for permanent harm, resulted in organ loss, led to reoperation or blood transfusion, or represented a deviation in anesthetic or surgical management. Major postoperative complications included those that were life-threatening or resulted in death, had potential for permanent harm, or required abdominal reoperation.

Of 277 eligible patients, 242 were enrolled. The mean age of participants was 17.1 years (range 13–19); 72% were white and 76% were female. The median BMI was 50.5. Overall, 49% of study participants had ≤3 comorbidities, 39% had 4 to 5 comorbidities, and 12% had 6 or more. The most common comorbidities were dyslipidemia (74%), sleep apnea (57%), joint pain (46%), hypertension (45%), and back pain (45%). The most common preoperative laboratory abnormalities included elevated C-reactive protein (75%), hyperinsulinemia (71%), low high-density lipoprotein (64%), and hypertriglyceridemia (40%). Microalbuminuria was detected in 18% of patients. Most participants (67%) had a Roux-en-Y gastric bypass (RYGB). The remainder either had a vertical sleeve gastrectomy (28%) or adjustable gastric banding (5%). All procedures were laparoscopic; only 1 required conversion to an open laparotomy.

There were 19 participants (7.9%) who experienced 20 major complications perioperatively and 7 participants (2.9%) who experienced 7 major complications postoperatively. Major perioperative complications included splenectomy secondary to intraoperative splenic injury (n = 1) and early reoperation for intestinal obstruction, bleeding, or gastrointestinal leak (n = 7). Major postoperative complications included pulmonary embolus (n = 2) and reoperation secondary to gastrointestinal leak (n = 2). There were no deaths. Procedure-specific rates of patients with major complications were highest with RYGB both peri- and postoperatively.

The authors conclude that WLS in obese adolescents has a low rate of major perioperative and postoperative complications.

Dr Snyder has disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

This is a well-planned and well-executed study...

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