A. L. Speer1, J. Parekh1, F. G. Qureshi2, E. P. Nadler1 1Children’s National Medical Center,Pediatric Surgery,Washington, DC, USA 2University Of Texas Southwestern Medical Center,Pediatric Surgery,Dallas, TX, USA
Introduction:
Morbid obesity affects millions of children and adolescents and its prevalence continues to rise. The incidence of obesity-related comorbidities in the pediatric population has also increased with a concomitant decrease in age of onset. Nonsurgical options do not result in significant or sustained weight loss in these children and thus bariatric surgery has become an increasingly utilized option. Bariatric surgery is known to be a safe and effective weight loss solution in morbidly obese adults, however, limited data exists regarding safety and efficacy for pediatric bariatric surgery outside of NIH-funded centers. We sought to assess the perioperative outcomes and safety of children and adolescents undergoing laparoscopic sleeve gastrectomy for morbid obesity at a free-standing children’s hospital which is not part of the NIH consortium.
Methods:
We retrospectively reviewed demographics, comorbidities, and 30-day complications for all patients who underwent laparoscopic sleeve gastrectomy during a 5 year period from 2010-2015 at a single free-standing children’s hospital that is not a member of the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.
Results:
A total of 105 patients underwent 107 laparoscopic sleeve gastrectomy procedures (2 revisions). The mean age was 17.3 years (4.5-24.8). The male to female ratio was 1:3.6. The majority of the patients were Black (56.2%), followed by White (22.9%), and Hispanic (17.1%). The mean Body Mass Index was 51.0 m2/kg (37.4-86.8). The most common comorbidities included obstructive sleep apnea (61.3%), hypertension (14.2%), diabetes (11.3%), nonalcoholic fatty liver disease (9.4%), and dyslipidemia (6.6%). Average length of stay (LOS) was 1.8 days (1-7). One patient was excluded from LOS as she was awaiting heart transplant and her LOS exceeded the 30-day outcome period. There were no deaths. Major complications occurred in 3 patients (2.9%) during their initial postoperative hospitalization requiring reoperation and in 1 patient (1.0%) after discharge before the 30th postoperative day. The reoperations were for gastric leak, epigastric bleed, and splenic parenchymal laceration. The fourth patient did not require reoperation but did require anticoagulation for pulmonary embolus and deep venous thrombosis. Minor complications were observed in 4 patients (3.8%). These included one submucosal hematoma requiring 2 weeks of TPN and three patients with decreased oral intake secondary to edema which required readmission for intravenous fluid hydration and steroids.
Conclusions:
Laparoscopic sleeve gastrectomy is a safe treatment option for morbidly obese children and adolescents and can be successfully performed at a non-NIH funded center. Future studies and more longitudinal data are necessary to confirm the long-term safety profile as well as the efficacy of bariatric surgery in the pediatric population.