Pre-Operative Medical Vs Post Sleeve Gastrectomy Weight Loss

Friday, October 10, 2014
Room 29 (San Diego Convention Center)
Avraham Schlager, MD1, Ragavan Siddharthan, BS1, Stephanie Moore Walsh, MD1, Sheethal Reddy, PhD2, Tamara Tanner, BSN, PhD2, Andrew Morris, MD1 and Mark Wulkan, MD1, (1)Emory University/Children's Healthcare of Atlanta, Atlanta, GA, (2)Children's Healthcare of Atlanta, Atlanta, GA

Purpose:  Adolescent bariatric surgery remains controversial despite studies showing its safety and efficacy.  Many feel that medical weight management is more approprite for  this population.  The purpose  of this study is to compare our comprehensive medical weight management program to sleeve gastrectomy in a surgery elegible population.   We aim to accomplish this by comparing pre-operative weight loss in our comprehensive weight management program to post-operative weight loss.

Methods:   All patients who have undergone sleeve gastrectomy at our tertiary care children’s hospital were identified.  In ou r program, patients are elegible for bariatric surgery if they have a BMI > 40, complete at least 6 months of a comprehensive weight management program,  be successful with goal oriented therapy, pass psychological evalutaion.   Only those with a clinic visit at least 4-8 months post-op were included in the analysis.  Retrospective chart data, as well as a prospective quality database were utilized for data extraction.  Height, weight, and BMI were collected when the patients presented to our clinic (T0), at their pre-operative clinic visit (T1), and their 4-8 month post-operative visit(T2).  The data was compared using a paired t-test.  Additionally length of hospital stay,  and peri/post-operative complications were cataloged.  

Results: 20 patients were identified who completed between 4-15 months of our comprehensive weight management program and then underwent sleeve gastrectomy.  16 were eligible for analysis based on followup criteria.  The mean  age was 15.8. There were 2 male and 14 female patients.   The mean BMI was 50.0 (44.2-74.3)/50.4 (40.7-68.0)/42.1 (33.9-56.2) at T0/T1/T0.  The mean  BMI change from T0 to T1 was +0.35 (P=.58).  The mean BMI change from T1 to T2 was a BMI - 8.26 (P=2.3 x 10^-7).  The mean length of stay was 3.3 (3-5) days.  There were no peri-operative complications.  Two patients were readmitted within 6 months post-operatively.  The first was for dehydration and the second was due to non-specific abdominal pain that subsided.

Conclusion: Sleeve gastrectomy demonstrated a statstically signficant decrease in BMI as compared to our medical weight loss program.  There was not a statistically significant change in BMI  for patients in the comprehensive weight management program.  In patients elegible for bariatric surgery, sleeve gastrectomy offers significant short term BMI decrease as compared to medical management.