|Tussing Humphreys, Lisa|
Submitted to: Journal of Pediatric Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/6/2009
Publication Date: 1/1/2010
Citation: Holterman, A., Brown, A., Tussing Humphreys, L.M., Gomez, S., Phipps, A., Browne, N., Stahl, C., Holterman, M. 2010. A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes. Journal of Pediatric Surgery. 45(1):74-8. Interpretive Summary: Obesity has reached unprecedented levels in U.S. adolescents. Surgical options in adults, including gastric bypass and gastric-banding, have been shown to be effective in reducing weight and improving obesity-related diseases overtime. To date, few studies have investigated the impact of gastric banding in adolescents, aged 14-17, over a sustained period of time on weight and disease status. The aim of this study was to investigate the impact of gastric banding on weight and disease status in 20 obese adolescents. At baseline, adolescents were morbidly obese based on body mass index, and roughly 90% had an impaired response to insulin and fat within their liver causing liver inflammation. At an average of 26 months after surgery, adolescents lost a significant amount of weight, had lower blood pressure, and reported improved quality of life. A little over two years, following gastric banding surgery, adolescents showed improvement in several areas supporting the efficacy of gastric banding, already observed in adults, to help treat obesity in this at-risk population.
Technical Abstract: The outcome of patients completing 12 months of follow-up in a prospective longitudinal trial of the safety/efficacy of laparoscopic adjustable gastric banding (LAGB), for morbidly obese adolescents aged 14 to 17 years using a Food and Drug Administration Institutional Device Exemption for the use of the LAPBAND was analyzed. Baseline and outcome data were abstracted from a prospective database. Baseline (mean ± SD) body mass index was 50 ± 10 kg/m2, and excess weight was 178 ± 53 lb in 20 patients. Comorbidities included hypertension (45%), dyslipidemia (80%), insulin resistance (90%), metabolic syndrome (95%), and biopsy-proven nonalcoholic steatohepatitis (88%). At mean (SD) follow-up of 26 (9) months, % excess weight loss was 34% ± 22% (n = 20) and 41% ± 27% (n =12), and the metabolic syndrome was resolved in 63% and 82% of the patients at 12 and 18 months, respectively. Hypertension normalized in all patients, along with improvement in lipid abnormalities and quality of life scores (P b .05). At 12 months, of the 5 patients with less than 20% excess weight loss, dyslipidemia and metabolic syndrome were resolved in 2 patients. At intermediate follow-up of a LAGB-based obesity treatment program, weight loss led to resolution or improvement of major obesity-related comorbidities in most patients, supporting the efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program and its long-term evaluation.