Taffy Makaya, Rebecca Poole and Kavitha Rozario
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criteria, 48 articles were fully reviewed, and two systematic reviews fulfilled
the criteria. The reviews included mostly non-RCTs, and did not identify any
RCT comparing bariatric surgery with no treatment, usual care, or waiting list
control. Findings from the review of mostly non-RCTs suggested that surgical
intervention in the management of severe obesity can lead to a substantial
weight loss. However, the actual magnitude of weight loss is generally
unclear. In one RCT, laparoscopic adjustable gastric banding resulted in
substantial weight loss, improvements in cardiovascular risk factors, as well as
improved quality of life when compared to an intensive lifestyle intervention
[114] with a suggestion that if the comparison group was given usual or
conventional care for obese children, the magnitude of the effect could have
been greater in this study. However, overall evidence for the safety and
effectiveness and of surgical interventions in treating of paediatric obesity
remains poor. Uncertainties around indications, patient selection criteria, post-
operative complications, and beneficial versus harmful outcomes beyond
weight loss in the short and long term still remain. The other question is How
long is 'long term' to assess benefits and harms associated with bariatric
surgery in paediatric populations needs further clarification especially when
considering that, depending on the age at surgery, a 24-month follow-up
would still mean assessing outcomes during childhood in certain patients.
Next Canoy and Yang looked at the different types of bariatric surgery
against each other. They found no direct information from RCTs on the effects
of different types of childhood or adolescent bariatric surgery. Of the surgical
techniques that have been used on of the key considerations to the technique of
choice is the reversibility or permanence of the procedure on the
gastrointestinal intestinal tract. They found no RCTs comparing the
effectiveness between surgical techniques or evaluating the benefits versus
harms of the different surgical techniques.
Canoy and Yang’s meta-analysis highlights the fact that there are very few
RCTs out there to assess childhood bariatric surgery. Until recently most data
has been gathered from case series reports, and most of these with fewer than
100 children. A recent pooled data analysis from a well-conducted meta-
analysis by Black et al. in the UK, published in August 2013 [115] in the
United Kingdom in August 2013, includes studies involving children aged
between 6 and 18 years and looked at outcomes across LRYGB, sleeve
gastrectomy (SG), and adjustable gastric band (AGB) Findings were noted to
be largely in keeping with previous meta-analytical results [116]. The mean
change in BMI at 12 months was −13.5 kg/m2 (95% confidence interval (CI)
−15.1 to −11.9). The authors were not able to provide summary estimates for