Preserved vision without growth retardation after laparoscopic Roux-en-Y gastric bypass in a morbidly obese child with pseudotumor cerebri: 36-month follow-up Daniel B. Leslie a, ⁎ , Todd A. Kellogg a , Kerri N. Boutelle b , Sean J. Barnett a , Sarah J. Schwarzenberg b , Andrew R. Harrison c , Sayeed Ikramuddin a a Department of Surgery, University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN 55455, USA b Department of Pediatrics, University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN 55455, USA c Department of Ophthalmology and Otolaryngology, University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN 55455, USA Key words: Adolescent; Severe obesity; Pseudotumor cerebri; Laparoscopic Roux-en-Y gastric bypass Abstract A 12-year-old boy presented with a weight of 136 kg and a history of progressive vision loss associated with unremitting pseudotumor cerebri requiring bilateral optic nerve sheath decompression. He underwent laparoscopic Roux-en-Y gastric bypass (RYGBP) without complication. At 36 months post-RYGBP, he has grown 5 cm since the time of surgery, his weight is 6.8 kg above his postoperative nadir weight of 68.2 kg, and his visual acuity has improved with OD 20/100 (preoperative, 20/200) and OS 20/70 (preoperative, 20/100). This case suggests that RYGBP can be performed safely and without stopping linear growth in carefully selected children. © 2008 Published by Elsevier Inc. Childhood and adolescent obesity has increased at an alarming rate for the past 10 years, and it is now estimated that 17% of children are obese and an additional 32% are overweight [1,2]. Moreover, it has been shown that at least 50% of children older than 6 years who are obese will continue to be obese into adulthood; this risk increases with the age of the child [3]. More recently, it has been found that while only 5% of children with body mass index (BMI) below the 50th percentile become obese adults, 84% of children with a BMI between the 95th and 98th percentiles do and all children with a BMI above the 99th percentile become obese adults [4]. The epidemic of childhood obesity has coincided with a dramatic rise in the incidence of impaired glucose tolerance and type 2 diabetes along with a broad range of comorbidities found in morbidly obese adults, including one of the less common comorbidities, pseudotu- mor cerebri (PTC) [5,6]. Treatment of PTC by weight loss surgery has been successful in adult series with resolution of persistent severe headache in all patients and dramatic reduction of cerebrospinal fluid pressure [7,8]. We report the 36-month follow-up after laparoscopic Roux-en-Y gastric bypass (RYGBP) of a 12-year-old morbidly obese boy who initially presented with progressive visual loss and papille- dema. Despite bilateral optic nerve sheath decompression, his vision deteriorated. This case report suggests that some morbidly obese children might benefit from weight reduction surgery, that linear growth is still possible after gastric bypass, and that definitive age cutoffs alone should not ☆ Supported in part by an unrestricted grant to the Department of Ophthalmology by Research to Prevent Blindness (New York, NY) and the Lions and Lionesses of Minnesota, Minneapolis, MN. ⁎ Corresponding author. E-mail address: lesli002@umn.edu (D.B. Leslie). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2008 Published by Elsevier Inc. doi:10.1016/j.jpedsurg.2008.05.001 Journal of Pediatric Surgery (2008) 43, E27–E30