A 1991 National Institutes of Health Consensus Conference concluded that severely obese adults could be eligible for
bariatric surgery if they had a body mass index (BMI) > or =35 kg/m(2) with or > or =40 kg/m(2) without
obesity comorbidity. It was thought at that time that there were inadequate data to support
bariatric surgery in severely obese adolescents. An estimated 25% of children in the United States are obese, a number that has doubled over a 30-year period. Very little information has been published on the subject of
obesity surgery in adolescents. Therefore we reviewed our 20-year database on
bariatric surgery in adolescents. Severely obese adolescents, ranging from 12 to less than 18 years of age, were considered eligible for
bariatric surgery according to the National Institutes of Health adult criteria.
Gastroplasty was the procedure of choice in the initial 3 years of the study followed by
gastric bypass, which was found to be significantly more effective for
weight loss in adults. Distal
gastric bypass (D-GBP) was used in extremely obese patients (BMI > or =60 kg/m(2)) before 1992 and long-limb
gastric bypass (LL-GBP) was used for superobese patients (BMI > or =50 kg/m(2)) after 1992. Laparoscopic
gastric bypass was used after 2000. Thirty-three adolescents (27 white, 6 black; 19 females, 14 males) underwent the following bariatric operations between 1981 and June 2001: horizontal
gastroplasty in one,
vertical banded gastroplasty in two, standard
gastric bypass in 17 (2 laparoscopic), LL-GBP in 10, and D-GBP in three. Mean BMI was 52 +/- 11 kg/m(2) (range 38 to 91 kg/m(2)), and mean age was 16 +/- 1 years (range 12.4 to 17.9 years). Preoperative comorbid conditions included the following: type II
diabetes mellitus in two patients,
hypertension in 11,
pseudotumor cerebri in three,
gastroesophageal reflux in five,
sleep apnea in six,
urinary incontinence in two,
polycystic ovary syndrome in one,
asthma in one, and degenerative
joint disease in 11. There were no operative deaths or
anastomotic leaks. Early complications included
pulmonary embolism in one patient, major
wound infection in one, minor
wound infections in four, stomal
stenoses (endoscopically dilated) in three, and
marginal ulcers (medically treated) in four. Late complications included small bowel obstruction in one and
incisional hernias in six patients. There were two late sudden deaths (2 years and 6 years postoperatively), but these were unlikely to have been caused by the
bariatric surgical procedure. Revision procedures included one D-GBP to
gastric bypass for
malnutrition and one
gastric bypass to LL-GBP for inadequate
weight loss. Regain of most or all of the lost weight was seen in five patients at 5 to 10 years after surgery; however, significant
weight loss was maintained in the remaining patients for up to 14 years after surgery. Comorbid conditions resolved at 1 year with the exception of
hypertension in two patients,
gastroesophageal reflux in two, and degenerative
joint disease in seven. Self-image was greatly enhanced; eight patients have married and have children, five patients have completed college, and one patient is currently in college.
Severe obesity is increasing rapidly in adolescents and is associated with significant comorbidity and social stigmatization.
Bariatric surgery in adolescents is safe and is associated with significant
weight loss, correction of
obesity comorbidity, and improved self-image and socialization. These data strongly support
obesity surgery for those unfortunate individuals who may have difficulty obtaining insurance coverage based on the 1991 National Institutes of Health Consensus Conference statement.