US research Adolescents favouring gastric band over bypass

Teenage patients are increasingly choosing laparoscopic adjustable gastric band (LAGB) over laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, according to a new study investigating the trends and outcomes of adolescents who undergo bariatric surgery in California.

In the study, ‘Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007’, patients younger than 21 years who underwent elective bariatric surgery between 2005 and 2007 were identified by researchers from the University of California (Los Angeles), from the California Office of Statewide Health Planning and Development database.

Using multivariate logistic regression factors were identified associated with the type of surgery. Gastric banding is not yet approved for use in teenagers by the Food and Drug Administration (FDA). The patients group included some 18, 19 and 20-year-olds for whom the surgery is FDA-approved.

A previous 2008 paper, published in the Journal of the American College of Surgeons, estimated that the number of teen bariatric surgeries performed nationally increased five-fold between 1997 and 2003.

A total of 590 adolescents (aged 13–20 years) underwent bariatric surgery in 86 hospitals. White adolescents represented 28% of those who were overweight but accounted for 65% of the procedures. While 43 percent of the overweight teenagers in California are female, 78 percent of the teenage surgical patients were girls. While more than half of overweight Californian teens are Hispanic, only 21 percent of those who underwent surgery were.

Rates of LAGB increased 6.9-fold from 0.3 to 1.5 per 100,000 population (p<0.01), whereas LRYGB rates decreased from 3.8 to 2.7 per 100 000 population (P<0.01). Self-payers were more likely to undergo LAGB (relative risk [RR]: 3.51 [95% confidence interval: 2.11–5.32]) and less likely to undergo LRYGB (RR: 0.45 [95% confidence interval: 0.33–0.58]) compared with privately insured adolescents. The rate of major in-hospital complication was 1%, and no deaths were reported. Of the patients who received LAGB, 4.7% had band revision/removal. In contrast, 2.9% of those who received LRYGB required reoperations.

The authors conclude that white adolescent girls disproportionately underwent bariatric surgery and although LAGB has not been approved by the US Food and Drug Administration for use in children, its use has increased dramatically.

Controversially, they also state that although ‘manufacturers have touted the banding procedure as less invasive, many [medical] centres have abandoned gastric banding because of poor long-term results,’ concerns about chronic oesophageal blockage, the need for frequent readjustments, and complications from the surgery.

The authors note that additional long-term studies are needed to fully assess the efficacy, safety, and health care costs of these procedures in adolescents.

“There is a perception that bariatric surgery in youth will help obese teens avoid a lifetime of illness,” said Marc Michalsky, surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, “However, if a patient undergoes one of these operations early, during their teenaged years, the result may be that they avoid the development of chronic obesity-related diseases that can result in permanent organ damage.”