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Published on: November 14, 2020
Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns
Aayed Alqahtani1, Mohamed Elahmedi, Awadh R Al Qahtani
1Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Laparoscopic sleeve gastrectomy (LSG) in children under 14 promotes significant growth compared to nonsurgical management. This bariatric surgery is safe and effective, improving comorbidities without serious complications.
Area of Science:
- Pediatric Endocrinology
- Bariatric Surgery
- Growth and Development
Background:
- Concerns exist regarding bariatric surgery for young children.
- Limited data on the impact of surgery on growth in prepubertal individuals.
Purpose of the Study:
- To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years.
- To compare outcomes of LSG in younger children versus older adolescents.
Main Methods:
- Retrospective matched control study using a multidisciplinary program database.
- Compared children (≤14 years) undergoing LSG with matched nonsurgical controls and older adolescents (>14 years) undergoing LSG.
- Generalized estimating equation analysis assessed growth patterns.
Main Results:
- Children under 14 (n=116) showed significantly greater monthly growth (0.9 mm/month) compared to nonsurgical controls.
- LSG in younger children resulted in lower comorbidity prevalence than in older adolescents (n=158).
- Comorbidity resolution rates were similar between age groups, with no significant difference in complication rates, mortality, or morbidity.
Conclusions:
- LSG is safe and effective for prepubertal children, challenging existing concerns.
- The procedure promotes significant weight loss and improved growth in this population.
- LSG leads to effective comorbidity resolution without increased risk of mortality or significant morbidity.
Objective:
To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on growth in children younger than 14 years in a matched control study.
Background:
Debatable concerns result in denying young children access to bariatric surgery.
Methods:
Our multidisciplinary program database was used to extract data of young nonsyndromic children (age ≤14 years) who underwent LSG. Patients were age, sex, and height z-score matched with those on nonsurgical weight management, and their results were compared with those of older adolescents (age > 14 years) who underwent LSG. Generalized estimating equation analysis was done to assess growth.
Results:
One hundred sixteen children younger than 14 years (mean ± SD, 11.2 ± 2.5 years) underwent LSG. Compared with the 1:1 matched group of nonsurgical weight management, these children experienced significantly higher growth, gaining 0.9 mm more per month on average. Compared with 158 adolescents (age, 17.3 ± 2.0 years) who underwent LSG in our institution, children younger than 14 years had a significantly lower prevalence of comorbidities (P < 0.001) but similar resolution rates (P = 0.72-0.99). There was no significant difference in the rate of complications (P = 0.77), and no mortality or significant morbidity was observed in any of the groups.
Conclusions:
This study challenges existing concerns regarding the safety and efficacy of bariatric surgery in prepubertal children. LSG is evidently safe and effective in this age group, resulting in significant weight loss, improved growth, and resolution of comorbidities without mortality or significant morbidity.
