Lap band surgery effective in combating obesity in adolescents

Jan 23 2007

Lap band surgery appears to be an effective procedure to combat obesity in adolescents, according to a new study conducted at NYU Medical Center.

It is the first study to evaluate the lap band in patients under the age of 17, and it revealed that patients on average lost about 50% of their excess weight by one year after surgery. The study is published in the January issue of the Journal of Pediatric Surgery. Currently, the lap band device is only approved by the Food and Drug Administration for use in adults.

NYU Medical Center is one of three sites currently approved by the FDA to study the efficacy of the gastric band in adolescent patients. To date, NYU physicians have the most experience with gastric banding procedures in adolescent patients in the United States.

Lap band surgery was performed on 53 morbidly obese adolescents between the ages of 13 and 17, according to the study. Most of the patients were girls. People are considered morbidly obese when their body mass index is at 40 or above, usually about 100 pounds overweight.

The patients in the study had a history of obesity for at least 5 years and many had conditions commonly found in obese adults such as high blood pressure, diabetes, and sleep apnea. They had also tried unsuccessfully to lose weight on numerous diet and exercise regimens, including medically supervised weight loss, according to the study. All of the adolescents were screened by a psychologist to ensure that they would comply with the study protocol.

"This study suggests that the lap band provides a safer and equally effective weight loss strategy compared to the gastric bypass," said Evan Nadler, M.D., Director of Pediatric Minimally Invasive Surgery and Assistant Professor of Surgery at New York University School of Medicine, who is the lead author of the study. "This is good news for parents contemplating obesity surgery for their adolescent children. The bypass has serious risks and side effects associated with it and our study shows that the band provides similar weight loss benefits without the same risks." Intestinal leakage and bleeding, blockage of the intestines, and severe nutritional deficiency are some of the side effects associated with the bypass procedure.

The gastric banding procedure places an inflatable silicon ring around the upper portion of the stomach, creating a smaller stomach, which helps patients feel full and limits the amount of food they eat. The ring is connected to a port that is placed underneath the skin at the time of surgery. At regular monthly visits, the ring can be made tighter or looser by injecting saline into the port. This minimally invasive procedure is usually performed in under an hour. It is reversible, adjustable, and requires no cutting or rerouting of the gastrointestinal tract.

By comparison, during the gastric bypass procedure the surgeon divides the stomach and reshapes it into a small pouch. It is then connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine.

According to the study, twelve and eighteen months following their surgery, the average weight loss for each patient was about 50 percent of excess weight, a figure comparable to weight loss following a gastric bypass procedure. None of the patients regained any lost weight, which has occurred after gastric bypass procedures, said Dr. Nadler.

Complications were found to be significantly less severe with the band procedure as well. None of the gastric band patients in the study had complications that required readmission to the hospital. Two patients experienced slippage of the band, two patients developed hiatal hernias, and one patient had a wound infection. All of these conditions were treated by outpatient procedures. According to the study, a few patients also experienced mild hair loss and iron deficiency which were treated with nutritional counseling and vitamin supplementation.