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ObesityWeek 2019

Biliary complication rates similar for adolescents and adults after LSG

In younger patients, the symptoms are more likely to manifest as pancreatic inflammation or acute pancreatitis

Adolescents and teens experience biliary side effects after laparoscopic sleeve gastrectomy at about the same rate as adults. However, in younger patients, the symptoms are more likely to manifest as pancreatic inflammation or acute pancreatitis, according to a study presented at ObesityWeek 2019, ‘The Pattern of Biliary Disease Following Laparoscopic Sleeve Gastrectomy in Adolescents’, and published in the journal Obesity.

Evan Nadler (Credit: Children's National Hospital

"Biliary issues after laparoscopic sleeve gastrectomy occur with about the same frequency in paediatric patients as they do in adults," said Dr Evan Nadler, senior author on the study and director of the Bariatric Surgery Program at Children's National Hospital. "We were surprised, however, to find that the small number of paediatric patients who do experience these complications seem to be more likely to have acute pancreatitis as a result. In adults, it's more commonly the gall bladder that acts up as opposed to the pancreas."

The study included 309 patients without previous or concurrent history of biliary disease or gallstones who had undergone laparoscopic sleeve gastrectomy at Children's National. Twenty-one patients (6.7% of the cohort), were diagnosed with biliary disease after surgery. Sixty-two percent of the paediatric patients with biliary disease also showed signs of acute pancreatitis, while only one-third of those with post-operative biliary disease presented with a gallstone blockage or biliary colic. In adults, biliary colic is a primary symptom after surgery and far fewer adults experience acute pancreatitis.

"We definitely need more research, across a more diverse population, to understand the mechanisms behind this higher likelihood of acute pancreatitis in paediatric patients," added Nadler. "More importantly, this study provides a proof point that weight-loss surgery doesn't pose any higher risk of biliary complications for kids than it does for adults."

Obesity's editorial team selected the study as one of the Top 5 most innovative scientific research studies to prevent and treat obesity in 2019. It appears in a special section of the November 2019 print edition. Nadler will present his findings during the Obesity Journal Symposium, as part of ObesityWeek, the annual meeting of The Obesity Society.

"We've got one of the largest, if not the largest, weight-loss surgery programs dedicated solely to caring for children and adolescents," explained Nadler. "That gives us a unique ability to collect and analyse a statistically significant sample of paediatric-specific patient data and really contribute a better understanding of how bariatric surgery specifically impacts younger patients."

In late October 2019, the American Academy of Pediatrics issued guidance with the aim of providing severely obese teens easier access to bariatric surgery.

"Our study is just the latest contribution to a significant body of evidence that weight-loss surgery should be considered a viable treatment approach for children and teenagers with severe obesity, an idea that is now endorsed by the nation's largest organization of paediatricians," he concluded.

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