Questions Remain On Bariatric Surgery For Adolescents

[MsJacquiiC]

Laparoscopic adjustable gastric banding surgery can effectively treat obesity in adolescents and seems to offer a better alternative than gastric bypass surgery, but further study is needed to determine whether it's better than nonsurgical options, a UT Southwestern Medical Center surgeon writes in an editorial in the Feb. 10 issue of the Journal of the American Medical Association.

Treatment of obesity in adolescents should be a priority because obesity portends other diseases, such as cardiac problems, hypertension and diabetes

"The latest research helps us define which surgical procedure may be preferable, but we are still a long way from settling the question of whether surgery should be used to treat obesity in teens," said Dr. Edward Livingston, chief of GI/endocrine surgery at UT Southwestern. The editorial accompanies a research study by Australian physicians examining weight-loss surgery among adolescents.

Treatment of obesity in adolescents should be a priority because obesity portends other diseases, such as cardiac problems, hypertension and diabetes, later in life, said Dr. Livingston, director of UT Southwestern's Clinical Center for the Surgical Management of Obesity.

Many physicians are reluctant to recommend weight-loss surgery as an obesity treatment for adolescents due to lack of research and data showing its effectiveness, Dr. Livingston said, so the latest contribution to the medical literature is a welcome addition.

While gastric bypass surgery permanently alters the stomach, laparoscopic adjustable gastric banding surgery can be reversed and has fewer complications, making it a better fit for the still-growing adolescent population, noted Dr. Livingston.

Australian researchers compared gastric banding surgery to medically supervised diets among 50 randomly assigned obese adolescents. The Australian data showed greater weight loss among patients receiving the bands, but complication rates raised questions about whether it was worth the benefit, Dr. Livingston said. In addition, the researchers found that while medical interventions successfully controlled many of the problematic disease complications without surgery, improvements were greater with surgery, he said.



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Hypertension Also referred to as high blood pressure, HTH, HTN or HPN, hypertension is a medical condition in which the blood pressure is chronically elevated. In current usage, the word "hypertension" without a qualifier normally refers to arterial hypertension. The Mayo Clinic specifies blood pressure is "normal if it's below 120/80".

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Laparoscopy Laparoscopic surgery, also called minimally invasive surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgical procedures. Laparoscopic surgery belongs to the broader field of endoscopy. The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system.

Obesity Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Diabetes Mellitus A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes mellitus: Type 1 Diabetes and Type 2 Diabetes. All forms of diabetes have been treatable since insulin became medically available in 1921, but there is no cure.

Gastric Banding Surgery The adjustable gastric banding is a restrictive surgical procedure during which a silicone band is placed around the stomach, creating a small pouch. The band includes a balloon that is filled with a nontoxic fluid, most commonly a saline solution; periodic adjustments are performed by a healthcare professional who accesses the balloon via a subcutaneous port. Gastric band placement, unlike malabsorptive weight loss surgery (e.g. Roux-en-Y gastric bypass surgery, Biliopancreatic Diversion, and Duodenal Switch), does not cut or remove any part of the digestive system. See WLS Videos for animated surgery technique.