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Laparoscopic Roux-en-Y Gastric Bypass in Adolescents with Morbid Obesity- Surgical Aspects and Clinical Outcome G. Göthberg, E. Gronowitz, C.-E. Flodmark, J. Dahlgren, K. Ekbom, S. Mårild, C. Marcus, T. Olbers
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S1055-8586(13)00067-X http://dx.doi.org/10.1053/j.sempedsurg.2013.10.015 YSPSU50460
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Seminars in Pediatric Surgery
Cite this article as: G. Göthberg, E. Gronowitz, C.-E. Flodmark, J. Dahlgren, K. Ekbom, S. Mårild, C. Marcus, T. Olbers, Laparoscopic Roux-en-Y Gastric Bypass in Adolescents with Morbid Obesity- Surgical Aspects and Clinical Outcome, Seminars in Pediatric Surgery, http://dx.doi.org/10.1053/j.sempedsurg.2013.10.015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Laparoscopic Roux-en-Y Gastric Bypass in Adolescents with Morbid Obesity- Surgical Aspects and Clinical Outcome G Göthberg1, E Gronowitz1, C-E Flodmark2, J Dahlgren1, K Ekbom3, S Mårild1, C Marcus3 and T Olbers1
1
Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, Dept. of Surgery, Medicine and Pediatrics and Centre of Obesity at the Queen Silvia Children’s Hospital, Gothenburg, Sweden
2
Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
3
Karolinska Institutet, Dept of Clinical Science, Intervention and Technology (CLINTEC) Division of Paediatrics, and National Childhood Obesity Centre, Children´s Hospital, Karolinska University Hospital, Stockholm, Sweden
Clinicaltrials.gov identifier: NCT00289705
Correspondence to: Dr Torsten Olbers, Dept for Gastrosurgical Research and Education, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden,
[email protected]
1
Abstract In this paper we address surgical aspects on bariatric surgery in adolescents from a nationwide Swedish study Eighty-one adolescents with morbid obesity (13–18 years) underwent laparoscopic gastric bypass surgery while 81 adolescents with obesity matched by age, sex, and BMI received conventional care. Another comparison group was adults undergoing gastric bypass at same institution during the same time period. This report addresses the two-year clinical outcome and five-year surgical adverse event rate. Body-weight decreased form 133 kg (SD 22) at inclusion to 92 kg (SD 17) after one year and 89 (SD 18) after two years (pIII and passed peak height growth velocity
Exclusion criteria - Severe or insufficiently treated psychiatric disorder - Ongoing drug abuse - Obesity due to syndromes, monogenic disease or brain injury - Reluctance to undergo long-term follow-up Eighty-two adolescents were recruited. They had been in a comprehensive conventional treatment program for at least one year and had passed the assessment for inclusion and exclusion criteria after meeting a pediatrician, psychologist and dietician. Recruitment took 4
place between Feb 2006 and April 2009. One of the patients refused surgery on the day of the operation; thus, 81 individuals (35% boys) underwent surgery (Table 1).
Controls Obese adolescent receiving conventional treatment= controls During the recruitment period, 81 adolescents (43% boys) were selected from the Childhood Obesity Register in Sweden (BORIS) as conventional treatment controls (Table 1.)
Obese adults treated with gastric bypass Eighty-one obese adults undergoing gastric bypass were matched by gender with the obese adolescents obtaining surgery, ensuring that date of surgery coincided within ±1 month (table 1). The inclusion age was 35–45 years at surgery; all other inclusion and exclusion criteria were the same as for the adolescents (Table 1).
Anthropometry, height and weight Height was measured to the closest centimeter using a wall-mounted standard stadiometer with the patient in standing position. Weight was measured with the subject in light clothing to the nearest 0·1 kilogram on an electronic scale, which was calibrated at regular intervals. In the adult group, weight was measured at inclusion and one year postoperatively, while twoyear weights were normally from measurement at their general practitioner. (Table 1.)
Surgery Surgical patients were instructed to remain on a low calorie diet (LCD) for the three weeks leading to surgery. The laparoscopic Roux-en-Y gastric bypass consisted of a small (
