Evolution and Outcomes of a Canadian Pediatric Bariatric Surgery Program

Adesola C Akinkuotu; Jill K Hamilton; Catherine Birken; Alene Toulany; Michele Strom; Rebecca Noseworthy; John Hagen; Elizabeth Dettmer; Jacob C Langer

doi:10.1016/j.jpedsurg.2019.01.038

Evolution and Outcomes of a Canadian Pediatric Bariatric Surgery Program

J Pediatr Surg. 2019 May;54(5):1049-1053. doi: 10.1016/j.jpedsurg.2019.01.038. Epub 2019 Feb 2.

Authors

Adesola C Akinkuotu¹, Jill K Hamilton², Catherine Birken³, Alene Toulany⁴, Michele Strom², Rebecca Noseworthy², John Hagen⁵, Elizabeth Dettmer⁶, Jacob C Langer⁷

Affiliations

¹ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: adesola.akinkuotu@sickkids.ca.
² Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
³ Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
⁴ Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ Department of General Surgery, Humber River Hospital, North York, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁶ Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
⁷ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.

PMID: 30808540
DOI: 10.1016/j.jpedsurg.2019.01.038

Abstract

Purpose: An interdisciplinary obesity management program was established in 2007 at our quaternary hospital, including bariatric surgery for selected adolescent patients. We report the evolution of surgical management within the program and outcomes following bariatric surgery.

Methods: This was a retrospective review of adolescents who underwent bariatric surgery between 2007 and 2017. All cases were performed by a pediatric surgeon and an adult bariatric surgeon. Baseline demographics, BMI, co-morbidities, and post-operative outcomes were recorded.

Results: Thirty-eight patients underwent bariatric surgery. Median age at entrance into the program was 16.5 (range, 12.1-17.4) years and at time of surgery was 17.4 (range, 13.6-18.8) years. Eight patients had laparoscopic adjustable gastric banding (LAGB) from 2007 to 10. Between 2011 and 2017, 18 had laparoscopic sleeve gastrectomy (LSG), and 12 had laparoscopic Roux-en-Y gastric bypass (RYGB). There were no intraoperative complications or conversions. Postoperative complications included wound infection, bleeding requiring transfusion and re-exploration, and internal hernia. Of patients who had LAGB, 2 required surgical revision, and 3 underwent subsequent removal.

Conclusions: Adolescent bariatric surgery in the context of a multidisciplinary obesity management program is safe and effective. RYGB and sleeve gastrectomy are associated with superior weight loss in the immediate post-operative period and at most recent follow-up and lower reoperation rates than gastric banding.

Level of evidence: III.

Keywords: Adolescent; Bariatric surgery; Obesity.

MeSH terms

Adolescent
Bariatric Surgery* / adverse effects
Bariatric Surgery* / statistics & numerical data
Canada / epidemiology
Child
Humans
Postoperative Complications / epidemiology
Reoperation / statistics & numerical data
Retrospective Studies