ABSTRACT
BACKGROUND: Metabolic and bariatric surgery (MBS) is gaining traction as a treatment option for adolescents with severe obesity. Since our weight center last published results in 2014, trends have shown increasingly diverse patient populations undergoing MBS and a shift from laparoscopic Roux-en-Y gastric bypass (LRYGB) to sleeve gastrectomy (LSG). We assessed outcomes including follow-up, weight loss, comorbidity resolution, and complications among our recent adolescent and young adult MBS patients. METHODS: This is a retrospective cohort analysis of patients under 21 years of age with severe obesity who underwent MBS at a single institution between 2014 and 2020. Data on demographics, comorbidities, body mass index (BMI), percent of total body weight loss (%TBWL) at various timepoints, and subsequent complications were collected via chart review. Regression examined associations between preoperative factors, follow-up, and %TBWL. RESULTS: There were 79 patients of whom 73% were female; overall, 53% were White, 24% Hispanic, and 15% non-Hispanic Black. The majority (80%) of patients underwent LSG. Three-fourths of patients had follow-up data beyond 1 year, and half beyond 3 years. The median %TBWL of LSG patients was 23% at a median follow-up of 3.0 years, and LRYGB patients 28% at 2.4 years. No preoperative factors were associated with follow-up or final %TBWL, but 6-month %TBWL predicted final %TBWL. Preoperatively, 73% of patients had at least one weight-related comorbidity, and 57% had documented improvements in at least one after surgery. There were three 30-day readmissions and no mortalities. CONCLUSIONS: This study, which is an update to a previous series from our center, reflects recent national trends with nearly half non-White patients and predominance of LSG over LRYGB. It adds to a growing body of evidence indicating that MBS is a safe and effective method of achieving weight loss and comorbidity resolution in adolescents with severe obesity.
ABSTRACT
INTRODUCTION: Glucagon-like peptide-1 receptor agonist (GLP-1A) medications are gaining widespread popularity for the treatment of obesity. The optimal use of these drugs in pediatric bariatric populations, and especially in those considering metabolic and bariatric surgery (MBS), is yet to be established. We sought to characterize current practice patterns of GLP-1A use at major pediatric bariatric centers across the United States. MATERIALS AND METHODS: We administered an online survey to a purposive sample of 46 surgeons who perform MBS on children and adolescents. Survey questions explored practices prescribing GLP-1As in patients considering MBS, holding them prior to elective operations, and restarting them postoperatively following MBS. Responses were summarized with descriptive statistics and inductive content analysis. RESULTS: There were 22 responses (48% response rate) representing 19 institutions. Most (86%) respondents do sometimes prescribe GLP-1As for patients considering MBS, but the specific indications vary. Practices for holding GLP-1As preoperatively also vary, from not at all to holding for 2 wk. Over half (55%) of respondents sometimes restart GLP-1As after MBS. Free-response themes included still-evolving preoperative utilization patterns, difficulty with access and insurance coverage, and a lack of data informing GLP-1A use in the pre and postoperative periods. CONCLUSIONS: Given the increasing use of these medications for weight loss purposes, this substantial variation in practice highlights a need for further research to examine the safest and most effective use of GLP-1As in the pre and postoperative periods and for practice guidelines to standardize care pathways in pediatric bariatric contexts.