Abstracts
2002 Digestive Disease Week

# 100609 Abstract ID: 100609 Bariatric Surgery for Severely Obese Adolescents
Harvey J Sugerman, Elizabeth L Sugerman, Eric J Demaria, John M Kellum Jr, Colleen Kennedy, Yvonne Mowery, Luke G Wolfe, Richmond, VA

A 1991 NIH Consensus Conference concluded that severely obese adults could be eligible for bariatric surgery with a body mass index (BMI)> 35 kg/m2 with or > 40 kg/m2 without obesity comorbidity. Severely obese adolescents may suffer from multiple comorbidities and social stigmitization. We reviewed our 20-year data-base for adolescents who had undergone bariatric surgery. Methods: Severely obese adolescents (age 12 to <18) were eligible for bariatric surgery according to the NIH adult criteria. Gastroplasty (GP) was the procedure of choice in the initial 3 years of the study followed by gastric bypass (GBP) that had been found to be significantly more effective for weight loss in adults. Distal GBP (DGBP) was used in extremely obese patients (BMI >60) prior to 1992 and Long-Limb GBP (LLGBP) for superobese patients (BMI >50) after 1992. Results: 32 adolescents (26 white, 6 black, 18 female, 14 male) underwent bariatric surgery between 1981 and June, 2001: 3 GP, 16 GBP (1 laparoscopic), 3 DGBP and 10 LLGBP, mean BMI 52+/-11 (range 38 to 91), age 16+/-1 (range 12.4 to 17.9). Pre-op co-morbidities: Type 2 diabetes 1, polycystic ovary 1, hypertension (HTN) 11, pseudotumor 2, GERD 6, sleep apnea 6, degenerative joint disease (DJD) 12. There were no postop deaths or leaks. Early complications included 1 PE, 1 major wound infection, 4 minor wound problems, 3 stomal stenoses (dilated endoscopically) and 4 marginal ulcers (acid suppression rx). Late complications: 1 bowel obstruction, 4 incisional hernias, 1 sudden death 6 years postop. Revisional procedures: 1 DGBP to GBP for malnutrition, 1 GBP to LLGBP for inadequate weight loss. There was resolution of comorbidities at 1 year except 2 HTN, 2 GERD, 7 DJD. Self-image was greatly enhanced: 8 have married; 5 completed college with 2 currently in college. Conclusions: Severe obesity is increasing rapidly in adolescents and is associated with significant comorbidity and social stigmitization. Bariatric surgery in adolescents is safe and associated with significant weight loss, correction of obesity comorbidity as well as improved self-image and socialization. These data strongly support surgery for these unfortunate individuals in whom it may be difficult to obtain insurance coverage based upon the 1991 NIH Consensus Conference Statement