Childhood Obesity in the United Kingdom 111who had undergone LSG. By 3 years post-procedure, remission of type 2
diabetes occurred in 95% of patients (95% CI, 85 to 100) of participants who
had diabetes at presentation, remission of abnormal kidney function occurred
in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to
97), remission of hypertension in 74% (95% CI, 64 to 84), and remission of
dyslipidaemia in 66% (95% CI, 57 to 74). Weight-related quality of life was
also reported to improve significantly.
Complications
Surgery is not without risk and the mortality in adults across all
procedures is 0.22%–0.34% (95% CI) [125, 126]. A similar risk in the
adolescent population would be more difficult to accept. There is one report so
far of a death following bariatric surgery in the “adolescent” population [127],
however this was a 19-year old male and could therefore actually classed as an
adult. In any case, the death of a young patient provided lessons on
cardiovascular disease in bariatric surgery in the young.
Other huge concerns are nutritional deficiencies which commonly already
exist in adolescents with severe obesity prior to bariatric surgery and
frequently often persist in the postoperative population [105]. Macronutrient
deficiencies include protein deficiency. However, micronutrient deficiencies
are more common, including trace elements, essential minerals, and water-
soluble and fat-soluble vitamins. Surgical sequelae, such as small intestinal
bacterial overgrowth, can promote such deficiencies, especially in patients
with T2DM. Dumping syndrome is another worrying complication. Concerns
have been raised concerning the potential impact of micronutritional
deficiencies in the preconception period and during pregnancy, with an impact
on both maternal and fetal health. There is concern over the impact of bariatric
surgery on the skeleton. Evidence shows reduced bone mineral density and
bone mineral content within a year following gastric bypass [121].
The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS)
study reported in 2014 on perioperative outcomes of adolescents undergoing
bariatric surgery [128]. There were no deaths during initial hospitalization or
within 30 days of the operation. Major complications - eg, reoperation were
seen in 19 patients (8%) while minor complications -eg, readmission for
dehydration- were noted in 36 patients (15%). All reoperations and 85% of
readmissions were related to the bariatric surgery. These results are clearly
very reassuring. Similarly in the case series by Sachdev et al. there was no
mortality reported and the only complication noted was a single port rotation
[123]. The Teen-LABS 2016 report quoted earlier [124] adds further 3-year