Review of current guidelines on adolescent bariatric surgery

A variety of European, North American and, recently, Middle East and Australasian guidelines are now available for clinicians treating obese children and adolescents. This review aims to synthesize recommendations from recent guidance to provide direction to clinicians on the appropriate use of bariatric surgery in adolescents. A literature search for English-language guidelines endorsed by national governments or professional health associations or societies was conducted, and subject experts were consulted to identify the most recently released guidance. Fifteen sets of guidelines were found, released in the past 6 years, of which nearly all suggested that bariatric surgery is indicated for obese paediatric patients after previous failed attempts at weight loss. Guidance was broadly similar in terms of the categories addressed (patient selection criteria, requirements of the surgical team and institution, and suggested preoperative and postoperative protocols), although relatively little consensus was evident among the criteria specified within these categories. Recommendations differed regarding the appropriate age and degree of obesity at which to intervene. Fewer guidelines addressed preoperative and postoperative care requirements, and of those that did the emphasis varied between familial care and involvement, psychological state and patient motivation, and the importance of long term care. There is a lack of uniformity in the guidance in this area, indicative of the complex nature of obesity management for younger patients. While guidance is necessary to inform and update clinicians, obese paediatric patients require individualized assessment and care.