Abstract 841: Laparoscopic Roux-en-Y Gastric Bypass in Morbid Obese Adolescents (AMOS Study)
Childhood obesity is associated with both immediate health problems and development of diseases such as type 2 diabetes and cardiovascular complications. Currently used medical interventions for extreme obesity in children rarely result in durable weight loss necessary to improve health outcome, prompting a search for more aggressive options, such as RYGBP.
Hypothesis RYGB surgical intervention in obese 13–18 year-old adolescents leads to:
sustainable reduction of body weight
reduction of secondary metabolic, inflammatory and cardiovascular risk factors
Methods 81 adolescents (mean 16.5 yo, 13.5–18.8, 52 female) were included and operated with RYGBP, where a small stomach pouch is created at the gastro-oesophageal junction and a Roux limb of small bowel is anastomosed to this pouch. Patients with failed conservative treatment and BMI > 40 or >35 with co-morbidities were included.
Results Mean inclusion body weight was 133±22 kg (SD) and BMI 45±6 kg/m2. 56 subjects had their 1-year follow-up and 19 their 2-year follow-up. 1 year after surgery patients weighed 92±17 kg (p<.0001) and had a mean BMI of 31±4 kg/m2 (p<.0001). Two years postop mean weight was 95±18 kg and BMI 31±4 kg/m2 (p<.0001 vs preop, ns vs 1-year). Fasting insulin fell from 30±17 to 8±4 mU/L and HbA1c from 4.4 to 4.2% ensuing RYGBP (p<.0001 for both). 1-year postop mean values fell for: LDL 2.6±0.8 to 2.0±0.6 mmol/L, triglycerides 1.3±0.6 to 0.8±0.2 mmol/L, ApoB 0.9±0.3 to 0.7±0.2 g/L, (p<.0001 for all), while ApoA1 rose from 1.1±0.2 to 1.3±0.2 mmol/L (p=.0015). Both leukocyte count and hs-CRP fell 1 year after surgery, 8.1±1.6 to 6.5±1.8*109/L and 6.9±5.4 to 3.5±6.4 mg/L, respectively (p<.0001, p=.015). Blood pressure fell from 124/78 to 117/71 mmHg. Gastric bypass surgery was remarkably well tolerated and only 2 patients received infection treatment and blood transfusion, conditions which resolved without long term sequelae.
Conclusion In our large material of obese adolescents, RYGBP surgery is safe and creates major positive outcomes in terms of sustainable weight reduction and cardiovascular and metabolic risk factors, together with biomarkers of inflammation. We would like to emphasise that these figures are based mainly of 1-year outcome, and patients need to be followed long-term.