Interventional gastroenterology

Lap band surgery: a first surgical option for obese teens


The longest prospective study of Australian adolescents receiving laparoscopic adjustable gastric banding for obesity has shown the procedure is safe and effective for up to five years.

However the procedure should be considered an interim procedure in a stepped approach to obesity management, the researchers said.

Paediatric surgeon Mr Sanjeev Khurana told the limbic there was no one perfect bariatric procedure and the pendulum of opinion had swung between lap banding (LAGB) and gastric bypass.

“The conventional wisdom is that once people reach a certain weight, they will always struggle with their weight. Given severe obesity is a chronic, lifelong condition, it should be expected that patients will have a number of interventions throughout their lives.”

The study followed 21 severely obese teenagers with a mean BMI of 47 who underwent surgery at the Women’s and Children’s Hospital in Adelaide.

Bodyweight and BMI improved significantly at six, 12, 24, 36 and 48 months after their surgery, with a mean BMI reduction of 10 kg/m2.

 Other measures of improvement included resolution of pre-diabetes in affected patients and improved quality of life scores.

There were no major operative complications however two patients later developed gall stone disease, which is known to be associated with significant weight loss rather than a particular procedure.

“Lap band surgery is the least invasive procedure which results in significant weight loss in the medium term,” Mr Khurana said.

“When considered as a time limited procedure, it is unlikely to create irreversible change to the oesophagus in most people.”

Seven patients had their band removed after an average of 3.5 years due to either weight loss failure or weight regain in keeping with preoperative advice to use the band as an interim procedure.

There were no band-related complications such as erosion or slippage.

International guidelines just released on the management of paediatric obesity recommend consideration of bariatric surgery in seriously obese, mature teenagers who have failed lifestyle modification.

 

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