Department of Surgery, Virginia Commonwealth University Medical Center, West Hospital 15(th) Floor Box 980645, Richmond, VA 23298.
Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth, University, Box 980140, Richmond, VA 23298.
J Pediatr Surg. 2019 Aug;54(8):1696-1701. doi: 10.1016/j.jpedsurg.2019.01.004. Epub 2019 Jan 23.
Metabolic and bariatric surgery in adolescents with severe obesity has been demonstrated to be safe and have long-term treatment efficacy. However, less than 0.1% of adolescents meeting criteria undergo surgery.
A prospective pilot study of adolescents who underwent laparoscopic gastric plication (LGP) was conducted to evaluate safety and effects on anthropometrics and weight-related medical and psychological comorbidities.
Four adolescents enrolled and underwent LGP; two withdrew 90 days postoperatively and two were followed through 36 months. Preprocedure body mass index was 41.7-53.7 kg/m with decreases in % change of BMI of 17.5% and 39.7% at 36 months after surgery. Patients reported early satiety, good hunger control, and limited nausea at all time points. There were no major complications. Mild gastroesophageal reflux and abdominal pain occurred; both resolved without surgical intervention. Minor improvements in psychological comorbidities were also reported.
LGP can be safely performed in adolescents with severe obesity and achieves modest weight loss. Although limited by its small sample size, this study provides preliminary support for LGP as an appropriate surgical option for adolescents. A larger, multidisciplinary study is planned.
Prospective case series review.
Level IV evidence: case series without comparison.
代谢和减重手术在严重肥胖的青少年中已被证明是安全的，并且具有长期的治疗效果。然而，符合手术标准的青少年中，不到 0.1%接受了手术。
对接受腹腔镜胃折叠术（LGP）的青少年进行了一项前瞻性试点研究，以评估安全性以及对人体测量学和与体重相关的医疗和心理合并症的影响。
有 4 名青少年入组并接受了 LGP；2 名在术后 90 天退出，2 名随访至 36 个月。术前体重指数为 41.7-53.7kg/m，术后 36 个月 BMI 的变化百分比分别下降了 17.5%和 39.7%。患者报告在所有时间点都有早饱感、良好的饥饿控制和有限的恶心。没有发生重大并发症。出现轻度胃食管反流和腹痛，但无需手术干预即可缓解。心理合并症也有轻微改善。
LGP 可安全用于严重肥胖的青少年，可实现适度的体重减轻。尽管受到样本量小的限制，但本研究初步支持 LGP 作为青少年合适的手术选择。计划进行一项更大的多学科研究。
前瞻性病例系列研究。
四级证据：无对照的病例系列研究。
