Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
VA Quality Scholars Program, Veterans Health Administration, White River Junction, VT, USA.
Obes Surg. 2019 Nov;29(11):3653-3664. doi: 10.1007/s11695-019-04048-3.
Metabolic and bariatric surgery is an effective strategy to curb the natural history of obesity progression and improve psychosocial status in the short term for adolescents with severe obesity. The medium- and long-term psychosocial impact of bariatric surgery in this population is not established.
We searched MEDLINE (Ovid), EMBASE, Web of Science, PsycInfo, and the Cochrane Libraries through October 2017 for reports of weight loss surgery (roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding) on adolescents with severe obesity (age ≤ 21 years) having ≥ 6 months of follow-up. The primary outcome for inclusion in systematic review was use of a validated quality of life (QoL) or other psychosocial instrument at baseline and postoperatively. We used standardized mean difference (SMD) and random-effects modeling to provide summary estimates across different instruments.
We reviewed 5155 studies, of which 20 studies met inclusion criteria for qualitative synthesis. There were 14 studies and 9 unique cohorts encompassing 573 patients which were eligible for meta-analysis regarding postoperative change in QoL. Across surgical procedures, there was significant improvement in QoL of 1.40 SMD (95% confidence interval 0.95 to 1.86; I = 89%; p < 0.001) at last follow-up (range 9-94 months). Trends in QoL improvement demonstrated the greatest improvement at 12 months; however, significant improvement was sustained at longest follow-up of 60+ months.
Weight loss surgery is associated with sustained improvement in QoL for adolescents with severe obesity across surgical procedures. Long-term data for psychosocial outcomes reflecting other mental health domains is lacking.
代谢和减重手术是一种有效的策略，可以遏制肥胖进展的自然史，并在短期内改善严重肥胖青少年的社会心理状态。然而，这种手术对该人群的中长期社会心理影响尚未确定。
我们通过 Ovid MEDLINE、EMBASE、Web of Science、PsycINFO 和 Cochrane Libraries 检索了截至 2017 年 10 月的报告，这些报告涉及对患有严重肥胖症（年龄≤21 岁）的青少年进行减肥手术（Roux-en-Y 胃旁路术、袖状胃切除术和可调胃束带术），并随访至少 6 个月。系统评价纳入的主要结果是在基线和术后使用经过验证的生活质量（QoL）或其他社会心理工具。我们使用标准化均数差（SMD）和随机效应模型来提供不同工具的综合估计值。
我们对 5155 项研究进行了回顾，其中 20 项研究符合定性综合的纳入标准。有 14 项研究和 9 个独特的队列，共纳入 573 名患者，有资格进行关于术后 QoL 变化的荟萃分析。在各种手术中，生活质量有显著改善，SMD 为 1.40（95%置信区间 0.95 至 1.86；I=89%；p<0.001），在最后一次随访（9-94 个月）。QoL 改善的趋势表明，在 12 个月时改善最大；然而，在最长 60 个月以上的随访中，仍保持显著改善。
减肥手术与严重肥胖青少年的生活质量持续改善相关，不同手术均有改善。缺乏反映其他心理健康领域的长期社会心理结局数据。
