الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 171 |  |  |
| | | from | 171 | | |
Abstract
O
besity is an increasing pandemic phenomenon. Over the past three decades, the prevalence of adult obesity in the world has doubled, while that of pediatric and adolescent obesity has tripled (Ogden et al., 2002). Current estimates classify 33.6 % of adolescents living in the USA as overweight, 18.4 % as obese, and 13.0 % as being extremely obese, defined as body mass index (BMI) ≥85th, 95th, and 97th percentile, respectively (Ogden et al., 2012). Individual, social, environmental, and economic factors contribute to the development and persistence of morbid obesity.
Pediatric and adolescent obesity is associated with preventable chronic health conditions like type two diabetes mellitus (T2DM), hypertension, obstructive sleep apnea syndrome (OSAS), dyslipidemia, nonalcoholic steatohepatitis, polycystic ovary syndrome, and various musculoskeletal diseases (Rocchini et al., 2011). Obese adolescents are likely to suffer from psychological morbidity, loss of self-esteem, and social exclusion which has the potential to scar them for life (Russell-Mayhew et al., 2012). These findings urge us to find ways to treat obesity early in life. Presently, Pediatric and adolescent obesity is mostly managed by combined lifestyle interventions focusing on behavioral and dietary modifications. These treatments are typically initiated and evaluated by a multi-disciplinary team including a pediatrician, dietician, psychologist, and a physiotherapist. While often effective in short term, long-term effects are relatively disappointing.
The last decades, various bariatric procedures have been performed in children and adolescents, including laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), vertical banded gastroplasty, biliopancreatic diversion, Endoscopic intra-gastric balloon and more recently laparoscopic sleeve gastrectomy (LSG). Potential adverse effects on growth and development in prepubertal patients who have not reached full maturity raise concerns. However, bariatric surgery relatively early in life intervenes before comorbidities become irreversible and reduces the risk of surgical complications.
Currently, the guidelines from the International Pediatric Endo-surgery group (IPEG) state that adolescents with a BMI >40 kg/m2 or a BMI >35 kg/m2 combined with severe comorbidities should be considered for surgical intervention, if they have (nearly) attained adult stature. The last few years, indication criteria for bariatric surgery have expanded, and surgical techniques have improved. However, the outcome and best techniques to treat morbidly obese adolescents remain relatively unknown.
In this review, we evaluate and compare the efficacy, safety, and benefits of various bariatric surgical techniques as a treatment for morbid obesity in adolescents. Our data are obtained with help of supplemental data from several authors and strengthened by inclusion of the most recent high-quality studies.
The 42 studies that were eligible for systematic reviewing represent the increasing interest in bariatric surgery in morbidly obese children and adolescents, although the studies were mainly observational and varied in quality. All main three procedures lead to significant weight loss in morbidly obese children and adolescents, and similar to a large Swedish study in adults, weight loss is most pronounced after RYGB. This seems to persist after both RYGB and LAGB. For LSG studies, long-term follow-up is not yet available. While adverse events are relatively mild and long-term complication rates are acceptable, they are more frequent and more serious after RYGB than after LAGB. In the currently available follow-up after LSG, the rate of adverse events appears to be similar to that after LAGB. Although a healthy nutritional status in children and adolescents is important to prevent developmental and growth deficiencies, standard postoperative vitamin supplementation regimens and the occurrence of deficiencies are not reported in most studies (not at all in LSG studies). However, more severe deficiencies occur after RYGB than after LAGB. Reduction of comorbidity, which is pivotal for health gain, is impressive in all techniques.