Bariatric surgery in children

During my Masters in Epidemiology we had to complete two essays, and a thesis. This paper was from my second essay. As I am not an expert in obesity surgery, two old colleagues from my time in London came on as co-authors (Billy and Russell from UCLH).

Abstract

The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric-adolescent bariatric surgery.

We aimed to;

  • systematically review the literature on bariatric surgery in children and adolescents
  • meta-analyse change in body mass index (BMI) 1-year post-surgery
  • report complications, co-morbidity resolution and health-related quality of life (HRQoL)

A systematic literature search (1955-2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model.

Metaanalysis
Meta-analysis of BMI change after bariatric surgery for adolescent obesity, by surgery type and overall. AGB, adjustable gastric banding; BMI, body mass index; BPD, biliopancreatic diversion; CI, confidence interval; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

In total, 637 patients from 23 studies were included in the meta-analysis. There were significant decreases in BMI at 1 year (average weighted mean BMI difference: -13.5 kg m(-2) ; 95% confidence interval [CI] -14.1 to -11.9). Complications were inconsistently reported. There was some evidence of co-morbidity resolution and improvements in HRQol post-surgery. Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents.

Reference

Black, J. A., White, B., Viner, R. M., & Simmons, R. K. (2013). Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis. Obesity reviews, 14(8), 634–44. doi:10.1111/obr.12037

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