Systematic review and meta-analysis of bariatric surgery for pediatric obesity

The prevalence of morbid obesity has risen sharply in recent years, even among pediatric patients. Bariatric surgery is used increasingly in an effort to induce weight loss, improve medical comorbidities, enhance quality of life, and extend survival. We performed a systematic review and meta-analysis of all published evidence pertaining specifically to bariatric surgery in pediatric patients.

We systematically searched MEDLINE, EMBASE, 13 other databases, and article bibliographies to identify relevant evidence. Included studies must have reported outcome data for > or =3 patients aged < or =21, representing > or =50% of pediatric patients enrolled at that center. We only included English language articles on currently performed procedures when data were separated by procedure, and there was a minimum 1-year follow-up for weight and body mass index (BMI).

Eight studies of laparoscopic adjustable gastric banding (LAGB) reported data on 352 patients (mean BMI 45.8); 6 studies of Roux-en-Y gastric bypass (RYGB) included 131 patients (mean BMI 51.8); 5 studies of other surgical procedures included 158 patients (mean BMI 48.8). Average patient age was 16.8 years (range, 9-21). Meta-analyses of BMI reductions at longest follow-up indicated sustained and clinically significant BMI reductions for both LAGB and RYGB. Comorbidity resolution was sparsely reported, but surgery did appear to resolve some medical conditions including diabetes and hypertension. For LAGB, band slippage and micronutrient deficiency were the most frequently reported complications, with sporadic cases of band erosion, port/tube dysfunction, hiatal hernia, wound infection, and pouch dilation. For RYGB, more severe complications have been documented, such as pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, staple line leak, and severe malnutrition.

Bariatric surgery in pediatric patients results in sustained and clinically significant weight loss, but also has the potential for serious complications.