Laparoscopic Banding in Adolescents Produces Major Weight Loss
Not only does laparoscopic gastric banding produce substantial weight loss in severely obese adolescents, but it also alleviates illnesses that go along with obesity, according to research presented at the 93rd Annual Clinical Congress of the American College of Surgeons (ACS).
Evan Nadler, MD, Assistant Professor of Surgery and Director of Minimally Invasive Paediatric Surgery, New York University School of Medicine, New York, New York, United States, and colleagues studied 25 morbidly obese youths, aged 14 to 17 years, who underwent laparoscopic adjustable gastric banding procedures.
Study subjects were evaluated for several measures of weight and body composition and also for comorbidities prior to surgery and again 1 year after the procedure, as part of a planned 5-year study.
Laparoscopic banding, in which an adjustable cuff is placed around the upper stomach through a small incision, has gained popularity as an alternative to conventional gastric bypass surgery due to apparently reduced mortality and morbidity.
In an oral presentation on October 8, Dr. Nadler said the 1-year follow-up results showed significant improvement in comorbid conditions as well as marked loss of body fat and overall weight.
Prior to surgery, 10 boys and 15 girls had a mean weight of 320 pounds, with mean fat mass of 136 pounds and mean body mass index (BMI) of 48. Android or central fat was 56% of total fat on average.
A total of 77 comorbidities were recorded preoperatively, or more than three per patient, Dr. Nadler said. Dyslipidaemia, diabetes, and musculoskeletal problems such as back pain and osteoarthritis were the most common.
At the 1-year evaluation, mean body weight had declined to 222 pounds, BMI to 35, and total fat mass to 100 pounds, of which android fat was 51%. Excess weight loss (weight greater than the ideal for a person's height and bone structure defined as excess) was 48%. All these declines were statistically significant (P <.01), Dr. Nadler said.
Perhaps as important was the fact that 40 of 60 comorbidities evaluable at follow-up had resolved entirely and 10 had improved, Dr. Nadler noted. The researchers could not evaluate changes in 11 cases of steatohepatitis and six cases of miscellaneous illnesses. Dyslipidemia, diabetes, hypertension and musculoskeletal conditions were most likely to improve, he said.
He noted that, on average, patients lost nearly as much lean mass as fat (28 pounds versus 36 pounds fat). He said it was most likely a physiologic response to the lost overall body weight. "We saw no negative impact" attributable to the lean mass loss, he added.
Among all children who may be considered overweight, surgical procedures should not take the place of dietary changes, exercise and other less invasive approaches to weight loss.
But in the morbidly obese population, from which the study sample was drawn, "these children are already too sick for those things to work," Dr. Nadler said. The long-term consequences of extreme overweight are so serious, and indeed life-threatening, that surgery, if effective, is entirely appropriate, he indicated.