Bariatric Surgery in Children and Adolescents- How Safe is it ?by Larry Oshiola Medical Consultant
The global epidemic of obesity is a serious health problem that not only impacts adults but also children and adolescents. Various studies and epidemiologic data are indicative of the enormous surge in the prevalence and severity of pediatric obesity.
Clinical studies have also revealed that obesity among adolescents increases mortality due to an association with co-morbidities i.e. obesity-related health problems.
Some of the other less serious co-morbidities may be:
- Fatty Liver
- Venous stasis disease
- Weight related arthropathy
- Urinary incontinence
- Significant impairment in the activity of daily living
- Non-alcoholic fatty liver disease (includes Steatohepatitis)
- Gastro-esophageal reflux
- Severe psychosocial distress
In the majority of people, dietary and lifestyle changes do not produce desired weight loss. Such cases require more aggressive or surgical treatment i.e. bariatric surgery.
Bariatric Surgery is a surgical procedure to lose weight by making changes in the digestive system such as:
- Making stomach smaller, allowing the patient to eat and drink less at one time and feel full sooner i.e. Restrictive Bariatric surgery
- Make changes in the small intestine—the part of the digestive tract that absorbs calories and nutrients from foods and beverages i.e. Malabsorptive/Restrictive Bariatric surgery
Types of Bariatric surgery for children and adolescents
As of now, the most common bariatric surgical procedures used for children and adolescents for treating obesity are:
- Roux-en-Y gastric bypass (RYGB)
- Laparoscopic Adjustable Gastric Banding (LAGB)
- Vertical Sleeve Gastrectomy
However, in certain cases, bariatric surgical procedures like Bilio-Pancreatic Diversion, Duodenal Switch Bypass and Intra-Gastric Balloon Surgeries are also performed.
Who is eligible for bariatric surgery?
A child or an adolescent is considered eligible for bariatric surgery if:
- BMI is 40 or more, with other less severe co-morbidities High Blood Pressure, High Cholesterol, Mild or Moderate Sleep Apnea and Pseudotumor Cerebri,
- BMI of 35 or more with at least one or more severe co-morbidities Type II Diabetes, Heart disease, Obstructive Sleep Apnea and Respiratory Disorders, Non-Alcoholic Fatty Liver Disease, Osteoarthritis, Lipid Abnormalities or Gastrointestinal Disorders
- BMI of 30 or more with a serious health problem linked to obesity, for the gastric band only
- Failed to achieve desired weight loss with prior organized conventional efforts at weight management for 6 months
- Willing to adhere to nutritional guidelines post-operatively
Safety with Bariatric surgery for children and adolescents
The objective of every bariatric surgery is to provide the children or adolescents, the desired benefits with least risks.
Bariatric surgery in India is nowadays performed using minimally invasive procedures with utmost accuracy and precision while reducing the size of the incision, blood loss, post-operative pain and recovery time.
The result and safety data of various studies have recorded reproducible, safe and effective results of children and adolescent bariatric surgery in India and abroad.
Not only bariatric surgery produces desired weight loss but also offer safe resolution of co-morbidities as seen in the adult obese population. Bariatric surgery for children and adolescents not only reduces risk of serious and non-serious co-morbidities but also improves co-morbid conditions like:
- Gastro-esophageal reflux disease i.e. GERD
- Heart Disease
- Obstructive Sleep Apnea
Accordingly, as reported by Vilallonga et al., 2016; Bariatric surgery through laparoscopic Roux-en-Y gastric bypass (LRYGB) for children and adolescent promises better quality life for later years by curing co-morbidities.
Several trials on Bariatric surgery have not only recorded reversal of co-morbidities but also shown to have improved Liver and Kidney Functions, Insulin Resistance and Type II Diabetes and reduction in Musculoskeletal Pain.
Bariatric surgery in India for children and adolescent is safe as it is performed by a multi-disciplinary specialist team consisting of:
- An experienced bariatric surgeon,
- A paediatrician with a speciality in endocrinology, gastroenterology
- A registered dietician
- A mental health specialist; a psychiatrist or psychologist
For effective yet safe and long-lasting weight-loss and improvement in many obesity-related conditions, children and adolescent can secure better and physically and mentally active life by undergoing bariatric surgery.
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