Long-term experience with duodenal switch in adolescents

Area of Science:

• Pediatric Surgery
• Bariatric Surgery
• Metabolic Disorders

Background:

• Severe and extreme obesity in children and adolescents is a progressive disease requiring surgical intervention.
• The optimal timing and choice of surgical procedures for adolescent obesity remain subjects of debate.
• Biliopancreatic diversion with duodenal switch (DS) is a surgical option for severe pediatric obesity.

Observation:

• A 16-year study involved 13 adolescents (aged 15-17) undergoing open DS, with follow-up ranging from 2 to 16 years.
• Three patients with Prader-Willi syndrome (PWS) were analyzed separately due to distinct postoperative courses.
• Long-term follow-up assessed weight, comorbidities, nutritional status, reproductive health, and neurodevelopment.

Findings:

• In non-PWS adolescents, DS resulted in significant mean BMI reduction (55.9 to 28.8 kg/m²) and 82.1% excess weight loss, with sustained results.
• All comorbidities resolved except asthma, which improved; two reoperations were needed for obstruction and ulcer.
• PWS patients experienced longer hospitalizations, shorter-term benefits (approx. 5 years), and higher complication rates, including one death post-reoperation.

Implications:

• DS demonstrates substantial long-term benefits for severe adolescent obesity, including significant weight reduction and comorbidity cure.
• While DS is effective in adolescents, careful consideration of risks is necessary, particularly for those with PWS.
• The procedure supports improved quality of life and reproductive health in successfully treated adolescents.