Bariatric surgery in adolescence

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.

During a 4-year period, the authors assessed 11 adolescent patients with severe morbid obesity. All patients underwent extensive preoperative evaluation including thorough psychological evaluation together with their families. Laparoscopic adjustable gastric banding (LAGB) was performed in all patients. Patients underwent follow-up for a mean of 23 months.

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/m2 (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/m2 with marked improvement in medical conditions and general psychologic well being. No late complications developed in any patient.

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 families, for the postoperative change in lifestyle and body image.