Is bariatric surgery (weight loss) a safe and effective option for severely obese children or adolescents?

Weight loss surgery among adolescents (aged 11-17) is becoming increasingly common in Europe and the US, but is still rare among Asian patients. According to estimates from U.S. News and World Report, about 1,500 to 2,000 teenagers receive bariatric surgery in the US each year, out of an estimated 180,000 overall cases including adults. In Asia, statistics show a monumental rise in child obesity: 46 million children were characterised as obese and 300 million described as overweight in China alone, according to a 2014 study.

Meanwhile, in Malaysia, often described as Southeast Asia’s ‘fattest’ country, over a quarter of children were reported to be overweight or obese. In light of this trend, Global Health and Travel asked bariatric surgeons across the region if they see weight loss surgery as a viable, safe option for dangerously obese teenagers who cannot lose weight by conventional means.

At the moment in Hong Kong, the guidelines for bariatric surgery currently exclude patients who are under 18. We have had, in the past, a few cases that we did surgery for adolescents, but they were under experimental trial settings in university hospitals.
Recently there’s been quite a bit more attention in particular from the US, in performing bariatric surgery for obese children or adolescents, with some pretty good results. However, the current consensus is that it’s not really for the average bariatric surgeon to apply this in Asia yet.

Currently there are just a few operations that have been studied for adolescents, like laparoscopic sleeve gastrectomy, laparoscopic gastric band, and gastric bypass. There are, of course a whole range of other surgeries that are available, but they might not be suitable for adolescents.

I think you have to look at this differently from adults. When we’re talking about bariatric surgery for adolescents or children, we’re talking about a different group of patients – these are the patients who are in development, in terms of growth, in terms of maturity. Particularly we’re concerned whether [bariatric surgery] would affect their growth – at the moment, in terms of evidence, there hasn’t been a lot of evidence to show that bariatric surgery does stunt growth or reduce the maturity of these patients.

But having said that, there haven’t been a lot of cases. There’s been a recent meta-analysis researching all the current evidence that does not really support the fact that adolescents or children who receive bariatric surgery have abnormal growth. Some selective studies have shown that bariatric surgery has improved heights of children – that’s a very interesting concept, but these are one-off studies.

Whether or not the surgery is reversible is also a major concern. If you provide a child or an adolescent with a surgery that’s irreversible – so in a number of years time when they become adults they wouldn’t have the option to reverse the surgery – that’s something needs to be discussed, because currently there are a number of surgeries that are reversible.

I think if an [adolescent] patient turns up at my clinic asking for surgery, I, unfortunately, might turn them down; but in a few years’ time, when there is more evidence, more trials, and more data, obviously that might change. With the epidemic of obesity, particularly with the rise of obesity in adolescents and young children, this will eventually become a problem, and we see that coming. We’ve applied various conservative methods to try to deal with obesity in terms of dietary, exercise and medication, with limited results.

Given the current literature – I expect that in the future, there will be more children coming to see me for considering bariatric surgery, having failed other means of trying to lose weight. If more turn up, at this point in time I’d have to tell them that this is not currently the standard practice in Hong Kong [outside the university hospital setting] and that would be frustrating.

Reference information:  http://www.obesitysurgery.com.hk/bariatric-surgery-children.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Five-Year Data: Surgery Betters Medical Therapy for Diabetes (Part 1)

Bariatric surgery is more effective than medical treatment alone for the long-term control of type 2 diabetes in obese patients, finds the first 5-year follow-up study, prompting a call for a rethinking of the diabetes care pathway with more emphasis on surgery.


Overall, 50% of patients who underwent surgery showed sustained remission of type 2 diabetes (defined as HbA1c less than 6.5%) without any medication upon 5-year follow-up, compared with none in the medically treated group.


"These people had nondiabetic glycemia for 5 years without ever taking a single antidiabetic drug," said Francesco Rubino, MD, senior author of the study and chair of bariatric and metabolic surgery at King's College London, United Kingdom.


And over 80% of surgically treated patients maintained the American Diabetes Association's (ADA's) treatment goal of HbA1c concentration below 7.0%, with just diet and/or metformin.


"This is a spectacular result," added Dr Rubino, although he acknowledged that the study involved only a small number of patients and was conducted at a single center.


The results were published in the September 5 issue of theLancet by Geltrude Mingrone, MD, of the Catholic University of the Sacred Heart, Rome, Italy, and colleagues, including Dr Rubino.


Like Cancer Treatment, Surgery Should Be Option in Diabetes


In an accompanying editorial, two other bariatric surgeons, Dimitri Pournaras, PhD, MRCS, and Carel le Roux, MBChB, PhD, both from Imperial College London, United Kingdom, draw a parallel with multimodal cancer treatment, where the best surgical treatment combined with the best medical treatment is better than either alone.


"This model could be followed for diabetes, with use of best medical care to maintain remission, which is often only possible with surgery," they write.


They suggest that future randomized controlled trials should assess the optimal point at which to use surgery, but that "all surgical groups should receive intensive medical treatment and close follow-up at some stage because, as [Dr] Mingrone and colleagues have now shown, not doing so results in relapse of diabetes."


Dr Rubino concurred, noting that the management of type 2 diabetes could come to resemble that of cardiovascular disease, with treatments ranging from diet and exercise, to drugs, to endoluminal stents or surgical bypass.


"Introducing surgical treatment in diabetes management allows escalation" of therapies according to disease severity and enables risk stratification, he told Medscape Medical News in an interview.





"If you know that surgery is an option, you give diet and drugs a reasonable time to work; if they fail, surgery should be considered," he added.






(Continue....)

Reference information: www.medscape.com
The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Laparoscopic Gastric Bypass (1)

 Gastric bypass is by far the most effective weight loss surgery for obese as well as diabetic patients with a success rate of over 80%. Gastric bypass is a combination of restrictive and malabsorptive weight loss surgeries. It reduces stomach volume and appetite while bypassing the duodenum to reduce calorie absorption in order to achieve significant weight loss. However, patients are required to take vitamins regularly and undergo regular checkups to prevent the risk of anemia.  

 

Procedure of Laparoscopic Gastric Bypass

Laparoscopic gastric bypass is suitable for patients with a BMI over 40. A liquid diet is suggested two weeks before the surgery. No food is allowed on the day before the surgery. Performed under general anesthesia, 4 to 5 small incisions will be made on the abdomen, each being 1-2 cm in diameter, so that laparoscopic instruments could be inserted. Gastrectomy will then be performed to reduce stomach volume by 20-30ml.

The ileum will then be connected to the stomach, bypassing the duodenum. The remaining part of the stomach will remain in the body for secreting gastric juices for iron and calcium absorption. The surgery takes around 2-3 hours. Patients have to be hospitalized for 4-5 days but may move around after surgery. Patients are advised to maintain a liquid diet for the first two weeks after surgery, and then progress to a puree diet. One month later, normal diet can be resumed. However, patients need to follow dietitians’ advice and exercise regularly, as well as undergo regular follow ups for effective weight loss.

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only.  Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Laparoscopic Gastric Bypass (1)

 Gastric bypass is by far the most effective weight loss surgery for obese as well as diabetic patients with a success rate of over 80%. Gastric bypass is a combination of restrictive and malabsorptive weight loss surgeries. It reduces stomach volume and appetite while bypassing the duodenum to reduce calorie absorption in order to achieve significant weight loss. However, patients are required to take vitamins regularly and undergo regular checkups to prevent the risk of anemia.  

 

Procedure of Laparoscopic Gastric Bypass

Laparoscopic gastric bypass is suitable for patients with a BMI over 40. A liquid diet is suggested two weeks before the surgery. No food is allowed on the day before the surgery. Performed under general anesthesia, 4 to 5 small incisions will be made on the abdomen, each being 1-2 cm in diameter, so that laparoscopic instruments could be inserted. Gastrectomy will then be performed to reduce stomach volume by 20-30ml.

The ileum will then be connected to the stomach, bypassing the duodenum. The remaining part of the stomach will remain in the body for secreting gastric juices for iron and calcium absorption. The surgery takes around 2-3 hours. Patients have to be hospitalized for 4-5 days but may move around after surgery. Patients are advised to maintain a liquid diet for the first two weeks after surgery, and then progress to a puree diet. One month later, normal diet can be resumed. However, patients need to follow dietitians’ advice and exercise regularly, as well as undergo regular follow ups for effective weight loss.

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only.  Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Laparoscopic Gastric Bypass (1)

 Gastric bypass is by far the most effective weight loss surgery for obese as well as diabetic patients with a success rate of over 80%. Gastric bypass is a combination of restrictive and malabsorptive weight loss surgeries. It reduces stomach volume and appetite while bypassing the duodenum to reduce calorie absorption in order to achieve significant weight loss. However, patients are required to take vitamins regularly and undergo regular checkups to prevent the risk of anemia.  

 

Procedure of Laparoscopic Gastric Bypass

Laparoscopic gastric bypass is suitable for patients with a BMI over 40. A liquid diet is suggested two weeks before the surgery. No food is allowed on the day before the surgery. Performed under general anesthesia, 4 to 5 small incisions will be made on the abdomen, each being 1-2 cm in diameter, so that laparoscopic instruments could be inserted. Gastrectomy will then be performed to reduce stomach volume by 20-30ml.

The ileum will then be connected to the stomach, bypassing the duodenum. The remaining part of the stomach will remain in the body for secreting gastric juices for iron and calcium absorption. The surgery takes around 2-3 hours. Patients have to be hospitalized for 4-5 days but may move around after surgery. Patients are advised to maintain a liquid diet for the first two weeks after surgery, and then progress to a puree diet. One month later, normal diet can be resumed. However, patients need to follow dietitians’ advice and exercise regularly, as well as undergo regular follow ups for effective weight loss.

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only.  Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.