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Although they represent fewer than 1 percent of all the bariatric procedures done, the number of teens having the operation has tripled in three years, a new study found.
"The number of bariatric procedures in adolescents has increased in the time period 2000 to 2003," said lead researcher Dr. Randall S. Burd, an associate professor of surgery in the division of pediatric surgery at Robert Wood Johnson Medical School, in New Jersey. "Even though these are a small percent of all the bariatric operations done in the U.S., the increase has been significant."
"Because there are still so few (teens getting the surgery), these cases need to be studied to determine what the short-term and long-term outcomes are going to be," Burd said. "It is probable that an adolescent who has this procedure will have different long-term outcomes than an adult who undergoes the same procedure," he said.
The findings are published in the March issue of the Archives of Pediatrics & Adolescent Medicine.
One common type of bariatric surgery is called gastric bypass, which involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions. Another common option is gastric banding, in which surgeons place a band-like device around the stomach to divide it into two smaller compartments.
In the study, Burd and his colleagues used data from a nationwide sample of community hospitals to determine the annual rate of bariatric surgery for teens between 1996 and 2003. During that period, 566 surgeries were done on adolescents at the sample hospitals. This represents a national estimate of 2,744 adolescents undergoing such procedures, Burd said.
The surgery rate did not change significantly between 1996 and 2000, the study found, but more than tripled between 2000 and 2003. Still, only 771 teens had the procedure in 2003, less than 0.7 percent of the 105,473 bariatric procedures performed that year.
Burd said that teens who had the operation did better than adults immediately after the surgery. "They had shorter hospital stays, and no child died after the operation. For adults, the death rate is 2 percent," he said. The complications rates were also lower for teens than for adults, he said.
One reason that teens do better initially than adults is because they usually don't have as many other serious medical problems. "The kids had fewer problems related to their obesity than adults," Burd said.
For obese teens who can't get a handle on their weight any other way, surgery may be the best option, Burd said. "The operation may allow us to prevent the long-term problems related to their obesity that they would have developed if we had waited for their operation until they were 30 or 40 or 50 years old," he said. "The operation is probably a good choice for kids."
One expert agrees that bariatric surgery can be a good option for teens, but only after careful evaluation.
"The biggest thing is to pick and choose patients very carefully," said Madelyn H. Fernstrom, director of the University of Pittsburgh School of Medicine's Weight Management Center. "The fact that there is not a huge increase in adolescent bariatric surgery despite the dramatic increase in adult bariatric surgery is a very good thing."
Fernstrom thinks bariatric surgery for teens must be part of a broader approach to weight management. "There are medical issues, there are psychological issues, there are family issues, there are environmental issues that need to be evaluated before surgery can be chosen as an option," she said. "Children are not miniature adults."
The success of the surgery also depends on making dramatic changes in diet and activity, Fernstrom noted. "Surgery is a tool to make lifestyle changes easier, and adolescents need to understand that and have the maturity to deal with it," she said.
SOURCES: Randall S. Burd, M.D., Ph.D., associate professor of surgery, Division of Pediatric Surgery, Robert Wood Johnson Medical School, New Brunswick, N.J.; Madelyn H. Fernstrom, Ph.D., director, Weight Management Center, University of Pittsburgh School of Medicine; March 2007, Archives of Pediatrics & Adolescent Medicine
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