Gastric surgery the latest idea in the U.S. to resolve obesity in children

Feb 5 2007

The popularity of stomach surgery in the United States to resolve obesity has greatly increased in the last few years but operating on obese children has rarely been done because of the considerable risks involved.

The American Society for Bariatric Surgery estimates that more than 177,000 Americans had weight-loss surgery last year, up from 47,000 in 2001.

But the combination of greatly improved surgical techniques along with obesity in the adolescent population reaching epidemic proportions has led doctors to re-consider using surgery to treat the condition in children.

According to federal statistics the number children who had surgery to remedy obesity was in 2004 only 350.

Now led by Cincinnati Children's Hospital Medical Center, a group of four hospitals will carry out a large-scale study examining how children respond to various types of weight-loss surgery, including the gastric bypass, in which a pouch is stapled off from the rest of the stomach and connected to the small intestine.

Another three hospitals have approval from the Food and Drug Administration to test how obese teenagers respond to a procedure called laparoscopic gastric banding, where an elastic collar installed around the stomach limits how much someone can eat.

Although the FDA has been reluctant to approve the gastric band for children, surgeons at New York University Medical Center believe the device holds promise for obese youngsters.

Researchers say although diet and behaviour modification can help a minority of teenagers, most patients go on to become obese adults.

The New York team conducted a study using gastric banding involving 53 youngsters aged 13 to 17; 41 were female and 12 were male.

The group lost almost half their excess weight over an 18 month period while suffering few complications.

Apparently two patients had band slips that required laparoscopic repositioning, and two patients developed a symptomatic hiatal hernia that required laparoscopic repair all of which were done as outpatient procedures.

A fifth patient developed a wound infection requiring surgery and drainage and other complications included mild hair loss in five patients, iron deficiency in four patients, a kidney stone and a gallstone in one patient, and reflux in another.

Evan Nadler, a pediatric surgeon and co-author of the study says the complications were minor compared to the chronic diabetes and cardiovascular disease the teenagers could expect to face if they remained obese through to adulthood.

Similar studies are being conducted at other hospitals but children are only considered candidates for surgery after they have spent six months trying to lose weight through conventional methods under hospital supervision, the success rates of which are not encouraging.

Many nutritional experts are critical of the procedure being used on such young people and regard it as a quick fix of which the long term consequences are unclear.