Laparoscopic weight-loss surgery improves health of morbidly obese teens

Teenagers' obesity-related medical complications improve just 6 months after laparoscopic gastric banding surgery, a new study found. The preliminary results will be presented at The Endocrine Society's 90th Annual Meeting in San Francisco. Previous studies suggest that this minimally invasive surgery, also called the "Lap-Band" procedure, is a safe and effective way for morbidly obese teens to lose weight, said the study's lead author, Ilene Fennoy, MD, a pediatric endocrinologist at Morgan Stanley Children's Hospital of NewYork-Presbyterian and clinical professor of pediatrics at Columbia University College of Physicians and Surgeons. The Food and Drug Administration (FDA) has approved the procedure for use in adults but not yet in teenagers. This study was part of the multidisciplinary FDA-approved Lap-Band Trial for Teens being performed at Columbia.

Extremely obese teenagers have obesity-related health problems, particularly diabetes and increased cardiovascular risk, such as high blood pressure, said Dr. Fennoy. Very obese teens have had to rely primarily on nonsurgical methods or higher-risk surgeries to lose weight. Until now, few treatments have succeeded in achieving major weight loss or greatly improving adolescents' medical complications of obesity, she said.

"Laparoscopic gastric banding offers the possibility of a new therapy for morbidly obese adolescents who have medical complications," Dr. Fennoy said.

The aim of this study was to document the impact of Lap-Band on the medical complications of obesity or their risk factors. Fourteen morbidly obese adolescents—six boys and eight girls—between the ages of 14 and 17 years participated. Patients received dietary counseling and encouragement to exercise, both before and after surgery.

This surgery involves making the stomach smaller without staples. Instead, a band goes around the upper part of the stomach, creating a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible.

Six months after the operation, patients lost an average of 20 pounds, Fennoy reported. The patients' blood pressure did not greatly change, but they had significant improvement in other measures of medical disorders, the researchers found. Several risk factors that are part of the metabolic syndrome improved, including abdominal fat, high triglycerides (levels of fat in the blood) and average blood sugar as measured by hemoglobin A1c. If untreated, these risk factors increase the chances of developing diabetes and heart disease. The patients' liver function and a measure of immune response also got better, according to the abstract.

"Laparoscopic gastric banding provides a reasonable solution for obese young people who need to lose a large amount of weight," Fennoy said.

Source: The Endocrine Society