5 OUTCOMES OF ADOLESCENT OBESITY TREATED WITH LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG) - UK SINGLE CENTRE EXPERIENCE
Joel Wong1, Martha Ford-adams1, Simon Chapman1, Avril Chang1, Lucy Stirling1,2, Beth Glassar1, Ashish Desai1
1King's College Hospital, London, United Kingdom. 2South London & Mauldsley NHS Trust, London, United Kingdom

Abstract

Aim of study: Laparoscopic sleeve gastrectomy (LSG) confers clinical improvement in morbidly obese adolescents but side effects are increasingly reported.  We aim to report our paediatric multidisciplinary team’s (Paed-MDT) outcome.

Methods: Records from 2012 – 2017 seen by pure Paed-MDT were retrospectively reviewed. Demographics, body mass index (BMI), % excess weight loss (%EWL), comorbidities and complications were recorded. %EWL was defined as [(preoperative weight – follow-up weight)/(preoperative weight – ideal weight)]x100. %EWL > 20 is considered success. Data are quoted as median (range).

Results: 19 (15 females) adolescents underwent LSG. Age was 17(13–19) years. Follow up was 9.8 (2.7–26.2) months. Preoperative BMI was 49 (39–65) kg/m2. Postoperatively, BMI was 37 (24–53) kg/m2. %EWL was 57 (21-106). Obesity related comorbidities showed improvement (Table 1). However, abdominal apron (n=4), nausea and vomiting (n=2), radiologically significant gastroesophageal reflux (n=1), constipation (n=3), hair loss (n=4) emerged. These were conservatively managed.

Vitamin D insufficiency (n=12) improved from 33 (<10-137) nmol/L preoperatively  to 54 (10-85) nmol/L post-operatively. All had intra-operative supplements. Postoperative de-novo deficiency in Vitamin D (n=2), iron (n=3), folate (n=4) and phosphate (n=4) were identified. Hypervitaminosis (n=2) occurred with folate and Vitamin B12 supplements. Patients with noncompliance to medications (n=3) and follow up (n=5) were sent reminders.

Conclusion

  • After LSG, weight and obesity related comorbidities showed clinical improvement in all cases.
  • There is a risk of de novo micronutrient deficiency and anaemia.
  • There is need for continued monitoring to review long-term outcome of weight and comorbidities.

 

Comorbidity

Preoperative(N)

Postoperative(N)

Insulin resistance

7

0

Diabetes

1

0

Hyperlipidemia

6

2

Hypertension

5

2

Non-alcoholic fatty liver disease

9

4

Polycystic ovarian syndrome

7

3

Acanthosis

5

4

Obstructive sleep apnoea

6

1

Table 1: Comorbidities in patients. N = number of patients.


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