RYGB is an effective approach for the management of obesity in selected adolescent patients

Roux-en-Y Gastric bypass (RYGB) is an effective approach for the management of obesity in selected adolescent patients, resulting in substantial weight loss and remission of obesity-associated medical problems, a systematic review and single-arm meta-analysis by an international team of researchers have found.

The study authors noted that whilst RYGB in adolescents with severe obesity has been shown to successfully reduce weight and BMI in the initial 6 months following surgery, there is a notable gap in existing literature in that no meta-analysis has comprehensively evaluated the long-term safety and effectiveness of RYGB in the adolescent population. Therefore, they performed a study to fill this gap by synthesising current evidence and assessing the enduring efficacy of RYGB in adolescents with severe obesity.

Their literature search identified 4,537 potentially relevant articles from which 12 studies met the inclusion criteria, with 522 patients who underwent primary RYGB procedures. Of the 522 patients, 63.8% were female and the mean age of the participants was 17.5 years (13-21 years). The baseline BMI of the population was 50.1 kg/m2, and the baseline weight was 149.3 kg. The mean follow-up was 48.4 months, with 18% of patients being lost to follow-up.

Preoperatively, 29.7% of patients had dyslipidaemia, 24.3% had hypertension, 12.2% had established T2DM and 15.6% had obstructive sleep apnoea syndrome (OSAS). Pre-operatively, 28.7% of patients had Vitamin D deficiency, 2.7% of patients had Iron deficiency and 0.9% had Vitamin B12 deficiency.

The absolute BMI loss was 14.8 kg/m2 at six months, 19.5 kg/m2 at one year, 18.3 kg/m2 at two years, 17.4 kg/m2 at three years 33,34,36 and 14.43 kg/m2 at five years. The percent total BMI loss was 26.6% at six months, 36.6% at one year, 35.3% at two years, 32.5% three years and 31.5% at five years. The percent excess BMI loss was 48.1% at six months, 67.7% at one year, 67.1% at two years, 60.9% at three years and 70.0% at five years.

Postoperatively, at final follow up, pooled dyslipidaemia remission rates were 84.8%, pooled hypertension remission rates were 73.1%, pooled T2D remission rates were 85% and pooled obstructive OSAS remission rates were 68.3%.

The most common postoperative nutritional deficiencies were vitamin D deficiency in 52.9% of patients, iron deficiency in 37% of patients and vitamin B12 deficiency in 11.8% of patients. Nutritional deficiency rates were compared preoperatively and postoperatively. The pooled estimate of Vitamin D deficiency demonstrated that there was no difference between the preoperative and postoperative groups. The pooled estimate of iron deficiency demonstrated that the postoperative group was more likely to develop a deficiency. The pooled estimate of Vitamin B12 deficiency demonstrated that the postoperative group was more likely to develop a deficiency.

The pooled complication rate was 29.1% (n=492) and the most common complications were the development of gallstones, internal hernias and intestinal obstruction. Minor complications comprised 10% with 50 reported complications, moderate complications comprised 11% with 54 reported complications, and serious complications comprised 7% with 36 reported complications. Five deaths were recorded with a pooled rate of 2.4% (n=301). All deaths were deemed to be unrelated to the primary RYGB procedure.

“This meta-analysis demonstrates that RYGB is an effective approach for the management of obesity in selected adolescent patients. It leads to substantial weight loss and remission of obesity-associated medical problems,” the authors concluded. “However, due to high rates of complications and risks of nutritional deficiencies, careful consideration must be taken, highlighting the critical need for routine long-term follow-up. Long-term trials are needed to explore these issues further.”

The findings were reported in the paper, ‘Long-term outcomes of RYGB in the adolescent population: A Systematic Review and Single-Arm Meta-Analysis’, published in SOARD. To access this paper, please click here