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Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched-control study
Aayed R Alqahtani1, Mohamed O Elahmedi1, Awadh R Al Qahtani1
1Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Laparoscopic sleeve gastrectomy (LSG) effectively reduces obesity and comorbidities in Prader-Willi syndrome (PWS) patients without impacting growth. This bariatric surgery offers a vital treatment option for PWS, addressing significant health risks.
Area of Science:
- Pediatric surgery
- Endocrinology
- Genetics
Background:
- Obesity is a primary cause of mortality and morbidity in Prader-Willi syndrome (PWS).
- Effective weight management strategies are crucial for improving health outcomes in PWS patients.
Purpose of the Study:
- To evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in pediatric PWS patients.
- To compare weight loss and growth in PWS patients undergoing LSG with a matched cohort of non-PWS patients.
- To assess the resolution of comorbidities following LSG in PWS patients.
Main Methods:
- A prospective clinical outcome study was conducted at an academic center.
- Data from PWS patients undergoing LSG were compared to a 1:3 matched non-PWS group.
- Follow-up data were analyzed for up to 5 years, assessing BMI changes, growth, and comorbidity resolution.
Main Results:
- PWS patients (n=24) showed significant BMI reduction post-LSG, comparable to non-PWS patients.
- No significant differences in postoperative BMI change or growth (height z-score) were observed between groups.
- 95% of comorbidities, including obstructive sleep apnea, dyslipidemia, hypertension, and diabetes mellitus, improved or resolved in both groups.
Conclusions:
- LSG is an effective weight loss intervention for pediatric PWS patients.
- LSG leads to significant comorbidity resolution without adverse effects on growth or increased mortality.
- Bariatric surgery like LSG should be considered for obese PWS patients due to limited alternative therapies and high mortality risk.
Background:
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS).
Objectives:
To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric patients with PWS compared with those without the syndrome.
Setting:
Academic center with a standardized care pathway for pediatric bariatric surgery as a part of a prospective clinical outcome study on children and adolescents undergoing weight loss surgery.
Methods:
Clinical data of all PWS patients who underwent LSG were abstracted from our prospective database, which included all pediatric patients who underwent bariatric surgery. These data were then compared with a 1:3 non-PWS group matched for age, gender, and body mass index (BMI). Data for up to 5 years follow-up were analyzed.
Results:
The 24 PWS patients (mean age 10.7; 6<8 yr old, range 4.9-18) had a preoperative BMI of 46.2 ± 12.2 kg/m(2). All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third, fourth, and fifth annual visits was -14.7 (n = 22 patients), -15.0 (n = 18), 12.2 (n = 13), -12.7 (n = 11), and -10.7 (n = 7), respectively, in the PWS group, whereas the non-PWS group had a BMI change of -15.9 (n = 67), -18.0 (n = 50), -18.4 (n = 47), -18.9 (n = 26), and -19.0 (n = 20), respectively. No significant difference was observed in postoperative BMI change (P = .2-.7) or growth (postoperative height z-score P value at each annual visit = .2-.8); 95% of co-morbidities in both groups were in remission or improved, with no significant difference in the rate of co-morbidity resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA and heart failure. No other readmissions occurred, and there were no reoperations, postoperative leaks, or other complications. No mortality or major morbidity was observed during the 5 years of follow-up. Among the PWS patients who reached their follow-up visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group it was 97%. All patients who missed a follow-up visit were subsequently seen in future follow-ups, and no patient was lost to follow-up in either group.
Conclusions:
PWS children and adolescents underwent effective weight loss and resolution of co-morbidities after LSG, without mortality, significant morbidity, or slowing of growth. LSG should be offered to obese PWS patients with heightened mortality particularly because no other effective alternative therapy is available.
