203 LAPAROSCOPIC SLEEVE GASTRECTOMY FOR SEVERE OBESITY IN ADOLESCENTS: TECHNIQUE AND PERIOPERATIVE RISKS
Varun Hathiramani1, Joel Wong1, Avril Chang1, Sasi Ramar1, Francesco Rubino1,2, Ameet Patel1, Ashish Desai1
1King's College Hospital, London, United Kingdom. 2King's College London, London, United Kingdom

Abstract

Aim of study: Laparoscopic sleeve gastrectomy (LSG) is increasingly performed in adolescents but is new technique for paediatric surgeons. We aim to report our evolving technique and it’s safety.

Methods: Records from 2012 – 2017 were retrospectively reviewed. Demographics, body mass index (BMI), pre-op co-morbidities, operative time, length of stay (LOS), additional procedures and perioperative complications were recorded. Data are quoted as median (range).

Results: 22 patients were operated. First 3 underwent Laparoscopic Gastric Band insertion and were excluded from this study.

19 patients underwent Laparoscopic Sleeve Gastrectomy. Age was 17(13-19) years. Pre op BMI was 51.5 (39-65) kg/m2. 18 had OGD and 14 had Tru-Cut Liver Biopsy at the same time. Total operative  time  was 155 (93-223) minutes.  2 had split leg position while rest were in supine position. 4-port access (n=12) was routinely used. Additional port was used in 7. Drain was not left in last 3 patients. Adult Surgeons assisted electively in 10 cases and as emergency assistance in 3 more cases.

Intra-operative complications of stapling the nasogastric tube (n=1), bleeding from the staple line and liver biopsy site (n=1) were treated successfully. Post-operative nausea, vomiting (n=6) were most common immediate post-operatively.  3 were investigated with contrast swallow (n=2) & CT scan (n=1). Left Lower Lung consolidation/effusion was noted in 1.

LOS was 4(2-8) days.  5 patients required High dependency unit (HDU) stay due to their comorbidities e.g. osteogenesis imperfecta(n=1), obstructive sleep apnoea (n=2), central hypothyroidism (n=1), Asperger syndrome, hypotonia and dyspraxia (n=1).

Conclusion:

  • LSG was performed safely with 4/5 ports.
  • Nausea, vomiting were common.  
  • HDU admission was dependent on patient’s comorbidities.
  • There was no anastomotic leak, but a low threshold for imaging was maintained.
  • LSG can be safely carried out in paediatric surgery setting with adequate training and supervision by adult surgeons.

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