Nine years follow up of the 1st Adolescent Bariatric Surgery in Spain
Corresponding author: Dr. Aniceto Baltasar, Tel: +34 675.070.195; Email: email@example.com
Adolescent Bariatric Surgery (ABS) is a new concept of bariatric surgery in full evolution. As in adults, the epidemic of obesity affects also children, with an incidence that is now increasing. Over the past 20 years, the prevalence of overweight in the US has tripled, reaching more than 15% of the child and adolescent population .
Our patient did not meet the established requirements, however, the clinical judgment of the bariatric team should finally determine the option of surgery in an individualized way, since the effectiveness of bariatric surgery in the weight loss of the patients and decreased co-morbidities when long-term conservative treatment is not sufficient .There are several publications currently on bariatric surgery performed on children who do not meet the criteria, with good initial results. Dan et al.  reported the case of a 6-year-old girl with morbid obesity (BMI 53.18 Kg/m²) with associated Blount disease as described in our patient. LSAFG was performed without complications and with good short-term results: BMI of 33.33 Kg/m² with %EWL-37% and 50% of %EBMIL.
Mohaidly et al.  have published a case of a 2-and-a-halfyear- old child with LSG due to morbid obesity (BMI 41 Kg/m²) and significant co morbidities (sleep apnea and tibia vara). After surgery, short-term results were also very satisfactory, with weight reduction (BMI 24 Kg/m²) and resolution of co morbidities.Villalonga  presented in his Initial Approach to Childhood Obesity , conducted by a multidisciplinary group of experts, that there was no agreement on variability inclusion criteria in bariatric surgery in children and adolescents.
Regarding the type of surgery, this same study suggests that there is currently no consensus, the two most prevalent options being LSG and Roux-en-Y gastric bypass (RYGBP). Biliopancreatic diversion (BPD) is not recommended due to the greater risk of complications after surgery and the possibility of malabsorptive complications, given the short age of the patients. As for the adjustable gastric band (BGA), although it is less invasive and with a lower rate of complications, its longterm results in adult patients are lower than in other techniques. In addition, gastric banding has not been approved by the “US Food and Drug Administration” in children under 18 years .
The RYGBP has good long-term weight loss results, but since it consists of a mixed technique (restrictive and malabsorptive), there is a risk of developing metabolic and nutritional alterations that can compromise the growth of the child. In addition, they are not exempt from major complications such as leakage, pulmonary thromboembolism, intestinal obstruction, internal hernias.
As for the LSG, it is the most commonly used technique at present and its use is increasing. The technique is simpler, has fewer risks in terms of surgical and malabsorptive complications and can always be converted to a RYGBP if surgery is not effective. However, we lack long-term studies to confirm their effectiveness.
Bariatric surgery in children and adolescents is an effective tool when dietary and lifestyle change measures are not helpful. The co morbidities that can be generated after obesity in the long term will significantly affect the quality of life of these patients, so it is necessary to avoid these complications early.
There is no consensus at present on which type of surgery is most effective, although it is suggested that LSG and RYGBP are adequate for these patients. Although it has been shown that its efficacy with respect to conservative measures is greater , there are still not enough studies comparing which of them is more favorable in this type of patients.
It is necessary to review the inclusion criteria in the ABS since there are cases of patients who do not meet these requirements but will benefit greatly from the surgery; And above all individualize each case according to the BMI and their co morbidities.
11. Vilallonga R, Moreno JM, Yeste D, Sánchez Santos R, Casanueva Freijo F et al. Initial Approach to Childhood Obesity in Spain. A multi society expert panel assessment. Obes Surg. 2016, 27(4): 997-1006.