Ten-year outcomes of LSG in paediatric patients
The results from a ten-year study of children and adolescents who underwent a laparoscopic sleeve gastrectomy (LSG) to treat severe obesity show they safely have long-lasting major weight loss and improvement of their obesity-related medical problems without stunting their growth in height. The study, ‘Ten-Year Outcomes of Children and Adolescents Who Underwent Sleeve Gastrectomy: Weight Loss, Comorbidity Resolution, Adverse Events, and Growth Velocity’, involves the longest known follow-up of paediatric patients after laparoscopic sleeve gastrectomy, was published in the Journal of the American College of Surgeons.
"Lack of long-term data and some paediatricians’ fears that bariatric surgery might affect children's linear growth has led to worldwide resistance to performing weight loss procedures for children below 14 or 15 years of age," said principal author, Dr Aayed R Alqahtani, professor of bariatric and minimally invasive surgery at King Saud University and chief executive officer of New You Medical Center in Riyadh, Saudi Arabia. "Our findings present clear evidence that should remove hesitance to perform bariatric surgical treatment in children and young adolescents who could benefit from the operation. We have a proven solution for severe obesity and its comorbidities."
In the prospective cohort study, 2,504 children and adolescents with class II/III obesity who were enrolled in a multidisciplinary, family-based paediatric obesity management programme underwent LSG between 2008 and 2021. Weight loss, growth, comorbidity resolution, and adverse event data during the first 10 years after LSG were analysed.
The study included patients aged five to 21 years at the time of operation and the majority (55%) were female. Mean percentage of excess weight lost during short- (1 to 3 years; n=2,051), medium- (4 to 6 years; n=1,268), and long-term (seven to ten years; n=632) follow-up was 82.3% ± 20.5%, 76.3% ± 29.1%, and 71.1% ± 26.9%, respectively. Complete comorbidity remission at long-term follow-up was observed in 74%, 59%, and 64% of type 2 diabetes, dyslipidaemia and hypertension cases, respectively. There were 27 adverse events (1%) with no procedure-related mortality.
Because many of their patients had not yet reached their full adult height, the researchers could compare growth velocity, the speed of growth in height, between younger and older paediatric patients. They found growth velocity was unaffected and did not differ between patients 14 or younger versus older than 14.
Al-Qahtani attributed their good results to factors including the following:
The surgeon used differences in the gastric sleeve they created, which he believes made it less likely to regain weight
Patients had permanent access to follow-up care and phone contact with the surgical and medical team; and
The patient's family helped ensure their child's compliance with post-surgery operative recommendations.
Their findings correspond with current scientific evidence recommending early surgical intervention, Alqahtani said. The most recent guidelines from the American Academy of Pediatrics and the American Society for Metabolic and Bariatric Surgery do not advise waiting until a child reaches maturity if the operation is recommended for the child based on their weight and obesity-related diseases.
"If you surgically intervene early, you can cure children's obesity-related diseases early and improve their quality of life, and if you wait longer, their diseases might become irreversible," he added.