ORLANDO — Sustained weight loss with few complications was achieved after gastric banding placed laparoscopically, according to a single-center series of 73 adolescents after 2 years of follow-up.
“The complication rate in our pediatric patients was about the same as the rate in adults, and the morbidity is milder than with gastric bypass,” Dr. Evan P. Nadlerand said at the annual meeting of the American Pediatric Surgical Association.
“Concerns about compliance by adolescents [who undergo gastric banding] seem unfounded, Dr. Nadlerand and colleagues wrote in their poster.
Dr. Nadler and his associates at New York University, New York, began performing laparoscopic gastric banding on morbidly obese teenagers aged 13–17 in September 2001. The average age of their first 73 patients was 15.8 years. Of these patients, 54 were girls, and their average preoperative body mass index (kg/m
During the first 6 months following gastric banding, average BMI dropped to 40 (with follow-up in 53 patients), and by 1 year after surgery, BMI averaged 34 (with follow-up on 47 patients). By 1 year after surgery, treated patients had lost an average of 57% of their excess weight.
These weight losses were maintained in those followed for longer than 1 year. After 18 months, mean BMI remained at 34 (30 patients followed), and after 2 years the mean BMI was 32 (16 patients followed). At 2 years of follow-up, the average amount lost was 61% of excess weight at baseline.
Of the 73 teenagers who received a gastric band, two later had their bands removed, one because of band slippage and the other because of gastric perforation. An additional five patients with slipped bands had them repositioned.
The most common complications resulted from nutritional deficits: mild hair loss (14 patients), iron deficiency (13 patients), and vitamin D deficiency (4 patients). These patients received nutritional counseling and supplements.
Other complications included three cases of hiatal hernia and three cases of gastroesophageal reflux.
In the first year after band placement, patients had an average of 10 office visits and required an average of six band adjustments.
In addition, 21 of the patients were more intensively evaluated and followed as part of a study for the Food and Drug Administration. These patients had 51 identified, obesity-related comorbidities at baseline. At 1 year after gastric banding, 35 (69%) of the comorbidities had completely resolved, 9 (18%) had improved, 5 (10%) showed no change, and 2 (4%) had worsened.