Bariatric Surgery in Adolescents, 1 Year Follow-Up of Co-Morbidities

Michalsky, Marc; Teich, Steven; Schuster, Dara P.
June 2007
Diabetes;Jun2007 Supplement 1, Vol. 56, pA472
Academic Journal
Purpose: Bariatric surgery is the only reliable method of achieving durable weight loss and improvement in obesity-related co-morbid conditions. With the exponential rise in childhood obesity and its associated co-morbidities, bariatric surgery is an option for the management of obesity in children. However there is little data on long term outcomes and impact on the co-morbid conditions. The objective of this study was to examine safety, efficacy and impact on comorbidities with Roux-en-Y gastric bypass (RYGB) among super-morbidly obese adolescents Methods: Five patients underwent RYGB and have been followed for at least 1year. Baseline clinical data, and the longitudinal effect(s) of RYGB on body mass index (BMI) and hypertension (HTN), Type 2 diabetes (DM) and obstructive sleep apnea (OSA) were examined. Changes in blood pressure, overnight sleep polysomnography and metabolic markers including insulin, glucose, c-peptide, bemoglobin-A1c were examined. Insulin resistance (IR) was determined by homeostatic model assessment (HOMA)-IR. Results: Initial screening demonstrated a prevalence of 60% for OSA, 80% for DM and 80% for HTN. Significant, ongoing reduction in mean BMI (61.7 to 41.4kg/m², p<0.001) was seen throughout the study period. Normalization of HgbA1c was observed by 20 weeks in all 4 patients with DM while the mean HOMA-IR levels demonstrated significant reduction as early as four weeks (p<0.001) with continued improvement up to 52 weeks (p<0.001) in all 5 subjects (5.8+/-0.7 to 1.7+/-0.7). Fasting insulin levels significantly declined from 55+/-7 to 13+/-7.0uU/ml over the 52 weeks. OSA resolved in 60% of patients by 20 weeks and 100% (3/3) by 52 weeks. HTN resolved in all patients with mean systolic BP at 20 weeks of I 18±3mmHg. There were no surgical complications. Conclusions: Bariatric surgery is safe, efficacious and associated with resolution of glucose intolerance, HTN and OSA in the super-morbidly obese adolescent population. These improvements in co-morbid conditions begin early in the post-operative period and play a significant role in the long-term improvement in quality of life for the individual. Prevention of the long-term complications could potentially negate the need for complicated medical regimens later in life. Bariatric surgery should be considered as a treatment option for supermorbidly obese adolescents with co-morbidities.


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