Koeck Emily, Davenport Katherine, Barefoot Leah C, Qureshi Faisal G, Davidow Daniel, Nadler Evan P
The George Washington University School of Medicine, Washington, DC, USA.
Clin Pediatr (Phila). 2013 Jul;52(7):608-11. doi: 10.1177/0009922813482516. Epub 2013 Mar 25.
As the obesity epidemic takes its toll on patients stricken with the disease and our health care system, debate continues regarding the use of weight loss surgery and its long-term consequences, especially for adolescents. One subset of patients regarding whom there is increased controversy is adolescents with extreme obesity (BMI > 60 kg/m(2)) because the risk of complications in this weight category is higher than for others undergoing bariatric surgery. Several strategies have been suggested for this patient group, including staged operations, combined operations, intragastric balloon use, and endoluminal sleeve placement. However, the device options are often not available to adolescents, and there are no data regarding staged or combined procedures in this age group.
All adolescents with BMI >60 kg/m(2) referred to our program were evaluated for inpatient medical weight loss prior to laparoscopic sleeve gastrectomy. The program utilizes a multidisciplinary approach with a protein-sparing modified fast diet, exercise, and behavioral modification.
Three patients completed the program, and each achieved significant preoperative weight loss through the inpatient program and successfully underwent bariatric surgery.
Presurgical weight loss via an inpatient program for adolescents with a BMI >60 kg/m(2) results in total weight loss comparable to a primary surgical procedure alone, with the benefit of decreasing the perioperative risk.
随着肥胖症的流行给患病患者和我们的医疗保健系统带来损害，关于减肥手术的使用及其长期后果的争论仍在继续，尤其是对于青少年。肥胖症患者中争议越来越大的一个亚组是极度肥胖（BMI>60kg/m²）的青少年，因为这一体重类别患者的并发症风险高于接受减肥手术的其他患者。针对该患者群体已提出了几种策略，包括分期手术、联合手术、使用胃内球囊和腔内袖带置入。然而，青少年往往无法获得这些器械选择，而且该年龄组关于分期或联合手术尚无数据。
所有BMI>60kg/m²并转诊至我们项目的青少年在接受腹腔镜袖状胃切除术之前均接受住院医疗减肥评估。该项目采用多学科方法，包括低热量蛋白质饮食、运动和行为矫正。
三名患者完成了该项目，每位患者通过住院项目在术前均实现了显著体重减轻，并成功接受了减肥手术。
通过住院项目对BMI>60kg/m²的青少年进行术前减肥，其总体体重减轻与单纯一次手术相当，且具有降低围手术期风险的益处。
