Objective: The prevalence of morbid obesity has risen sharply in recent years, even among pediatric patients. Bariatric surgery is used increasingly in an effort to induce weight loss, improve medical comorbidities, enhance quality of life, and extend survival. We performed a systematic review and meta-analysis of all published evidence pertaining specifically to bariatric surgery in pediatric patients.
Methods: We systematically searched MEDLINE, EMBASE, 13 other databases, and article bibliographies to identify relevant evidence. Included studies must have reported outcome data for ≥3 patients aged ≤21, representing ≥50% of pediatric patients enrolled at that center. We only included English language articles on currently performed procedures when data were separated by procedure, and there was a minimum 1-year follow-up for weight and body mass index (BMI).
Results: Eight studies of laparoscopic adjustable gastric banding (LAGB) reported data on 352 patients (mean BMI 45.8); 6 studies of Roux-en-Y gastric bypass (RYGB) included 131 patients (mean BMI 51.8); 5 studies of other surgical procedures included 158 patients (mean BMI 48.8). Average patient age was 16.8 years (range, 9–21). Meta-analyses of BMI reductions at longest follow-up indicated sustained and clinically significant BMI reductions for both LAGB and RYGB. Comorbidity resolution was sparsely reported, but surgery did appear to resolve some medical conditions including diabetes and hypertension. For LAGB, band slippage and micronutrient deficiency were the most frequently reported complications, with sporadic cases of band erosion, port/tube dysfunction, hiatal hernia, wound infection, and pouch dilation. For RYGB, more severe complications have been documented, such as pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, staple line leak, and severe malnutrition.
Conclusions: Bariatric surgery in pediatric patients results in sustained and clinically significant weight loss, but also has the potential for serious complications.
Eighteen studies (641 patients) of obese patients aged 21 or less reported outcomes after bariatric surgery. Meta-analyses of body mass index indicated sustained and clinically significant reductions for both gastric banding and gastric bypass. Postoperative complications of banding included band slippage and micronutrient deficiency, whereas for bypass, more severe complications have been reported.
From ECRI Institute, Evidence-Based Practice Center and Health Technology Assessment Information Service, Plymouth Meeting, Pennsylvania.
The authors declare that there was no commercial sponsorship of the manuscript.
This publication is derived from work supported under a contract with the Washington State Health Care Authority (contract number 6020-001788) to support its Health Technology Assessment Program.
Reprints: Laurie Menyo, ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462. E-mail: email@example.com.