Bariatric Surgery in Adolescence By Subhi Abu-Abeid, Nancy Gavert, Joseph M. Klausner, and Amir Szold Tel Aviv, Israel Background/Purpose: Surgical treatment for morbid obesity is relatively contraindicated in patients less than 18 years of age. However, on some occasions, there is extreme obesity in this age group that does not respond to nonsurgical treatment. The aim of this study was to evaluate the surgical management of severe morbid obesity in adolescents. Methods: During a 4-year period, the authors assessed 11 adolescent patients with severe morbid obesity. All patients underwent extensive preoperative evaluation including thor- ough psychological evaluation together with their families. Laparoscopic adjustable gastric banding (LAGB) was per- formed in all patients. Patients underwent follow-up for a mean of 23 months. Results: The mean age of the 11 children in this study was 15.7 years (range, 11 to 17 years). Associated conditions included heart failure and pulmonary hypertension in one patient, amenorrhea in 2 patients, and gallstones in 1 patient. Mean preoperative body mass index (BMI) was 46.4 kg/m 2 (range, 38 to 56.6). There were no operative complications. Over a mean follow-up period of 23 months (range, 6 to 36 months), the mean BMI dropped from 46.6 to 32.1 kg/m 2 with marked improvement in medical conditions and general psy- chologic well being. No late complications developed in any patient. Conclusions: Children are routinely excluded from bariatric surgery programs because of the difficulties involved in psychologically and cognitively preparing this population for surgery. However, extreme morbid obesity rarely responds to nonsurgical therapy for any extended period. This select population will benefit from bariatric surgery if an effort is made to properly prepare patients, together with their fam- ilies, for the postoperative change in lifestyle and body image. J Pediatr Surg 38:1379-1382. © 2003 Elsevier Inc. All rights reserved. INDEX WORDS: Morbid obesity, surgery, adolescents. M ORBID OBESITY in youth is a growing problem in the western world. Up to 22% of children have a body mass index above the 85th percentile. 1,2 Obesity in adults is associated with significant health risks and increased early mortality, 3 and obese children often be- come obese adults. 4 In addition, obese children them- selves suffer from significant morbidity, both psycholog- ical and physical, with an increased incidence of type II diabetes mellitus, hypercholesterolemia, and poor body image. 5 Weight loss in adolescents has been shown to decrease the risk factors for coronary disease. 6 Also, decreasing obesity-related mortality in adults depends on early weight loss while still in adolescence, and the sooner the better. 4 Despite the benefits of weight loss in the severely obese adolescent population, bariatric surgery has been discouraged because of the difficulty in preparing these patients for the change in lifestyle as well as the extended follow-up and compliance necessary for success. In ad- dition, the nutritional complications that may arise after this type of surgery are unknown and may influence growth and sexual maturation. Nonoperative treatment for obesity is notoriously in- effective in the longterm 7 and thus the severely obese adolescent, although difficult to treat, would be expected to benefit from bariatric surgery if properly prepared and supported throughout the pre- and postoperative periods. This study retrospectively evaluates the success of bari- atric surgery in 11 severely obese adolescents in whom nonoperative management had failed. MATERIALS AND METHODS Eleven adolescents aged 11 to 17 years, were studied. Eight patients were girls and 3 were boys. The mean BMI was 46.6 kg/m 2 (range, 38 to 56.6), and all patients fulfilled the National Institutes of Health (NIH) criteria for morbid obesity. The patients were treated and underwent follow-up in a multidisciplinary center dedicated to the treatment of obesity. The center includes staff from the departments of surgery, medicine, pediatrics, nutrition, psychology, social services, endocrinology, imaging, and plastic surgery. Before referral to our center, the adolescents had been under the care of a dietitian for at least 1 year and had failed to reduce weight despite a low calorie diet of about 800 Kcal/d. No patients were treated medically because the efficiency of these drugs in adults is still not proven, and the long-term effect in children is unknown. 8 In addition, 3 patients had had their jaws wireclamped, and 2 patients had been From the Department of Surgery B and the Endoscopic Surgery Service, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Address reprint requests to Subhi Abu-Abeid, MD, Department of Surgery B, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, Tel- Aviv, Israel, 64239. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3809-0020$30.00/0 doi:10.1016/S0022-3468(03)00400-7 1379 Journal of Pediatric Surgery, Vol 38, No 9 (September), 2003: pp 1379-1382