An Adolescent Multidisciplinary Bariatric Surgery Program

Friday, October 10, 2014
Room 29 (San Diego Convention Center)
Sigrid Bairdain, MD, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, Nirav Desai, MD, Boston Children's Hospital, Harvard Medical School, Boston, MA and Bradley C. Linden, MD, Pediatric Surgical Associates, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN

Purpose: The current estimates of the prevalence adolescent morbid obesity and severe morbid obesity are 21% and 6.6%, respectively.  Obesity, if left untreated, may result in a variety of comorbid conditions. Similar to adults, those comorbid conditions include: 1) hypertension; 2) insulin resistance and type II diabetes mellitus; 3) obstructive sleep apnea; 4) hyperlipidemia; 5) polycystic ovarian syndrome (PCOS); and, 6) depression and anxiety.  Thus, we aimed to describe a cohort of adolescent patients undergoing bariatric surgery to: 1) describe their surgical outcomes 12 months following surgery; and, 2) outline a model for an adolescent multidisciplinary bariatric surgery program.

Methods: We reviewed all adolescents, who participated in our bariatric surgery multidisciplinary program from January 2010 to December of 2013. Patients were included if they had at least 12 months follow-up following their surgery. Adolescents were evaluated by a multidisciplinary team consisting of a surgeon, pediatric gastroenterologist, dietitian, psychologist, and licensed social worker; each clinic visit was tailored to the individual patient. The number of preoperative clinical visits and time to surgery, anthropometrics, clinical variables and complications were recorded. Main outcome measure was the percentage excess body mass index (%EBMIL) lost.

Results: From January 2010 to December 2013, data from 11 patients were analyzed. Ninety percent (n=10) were female. Median age at surgery was 17 years (range: 14-20 years). 45% had insulin resistance and 100% had depression and anxiety. Median time to surgery was 6 months. Median number of visits per specialist was: Surgeon: 2 visits (range 2-4 visits); Pediatric Gastroenterologist: 5 visits (range 4-8 visits); Dietician: 6 visits (range: 3-11 visits); and, Licensed Social Worker: 4 visits (range 3-5 visits).  Median preoperative body mass index (BMI) was 48.2kg/m2 (range: 40-58.2kg/m2).  All patients underwent a laparoscopic Roux-en-Y Gastric Bypass (RYGB) and 45% (n=5) had a concomitant hiatal hernia repair. Median length of stay was 3 days (range: 2-4 days). There were no complications. At 1 year follow-up, median %EBMIL was 66.7% (range: 14.5%-92%) and all had resolve on their insulin resistance.

Conclusions: Adolescents followed in a multidisciplinary bariatric surgery program showed an improvement in their BMI, clinical conditions, and suffered no complications. Future studies on a large scale are needed to show a continued improvement in their medical and anthropometric profiles.