Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States; Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, United States.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States.
J Pediatr Surg. 2022 Aug;57(8):1654-1659. doi: 10.1016/j.jpedsurg.2021.08.018. Epub 2021 Sep 5.
The prevalence of childhood obesity in the U.S. has tripled over the last three decades. However, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year.
All patients age 10 to 19 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 through 2018 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were included in this retrospective cohort analysis. The primary outcomes were mortality and overall complications. Procedural trends, readmission and reoperation rates were also examined using a multivariate regression model.
Patients had a mean BMI of 47.3 kg/m and 80.0% were either 18 or 19 years old (n = 4,051). There were two reported deaths. Reoperation within 30 days occurred in 1.1% of patients, readmission in 3.5%, and complications in 1.2%. Among all readmissions, primary reasons included nausea/vomiting or nutritional depletion (41.3%) and abdominal pain (16.3%). RYGB was associated with higher odds for readmission (p = 0.006) and complications (p = 0.005). Higher BMI and younger age were not associated with an increased likelihood to experience poorer outcomes. The proportion of patients undergoing SG increased yearly over RYGB from 73.9% in 2015 to 84.3% in 2018.
Bariatric surgery appears to be low risk for adolescents and SG has become the operation of choice. More research on early consideration of surgical therapy in adolescents with severe obesity is needed given the safety profile.
III.
美国儿童肥胖的患病率在过去三十年中增加了两倍。然而，每年只有不到 1%的重度肥胖儿童接受手术减肥干预。
本回顾性队列分析纳入了 2015 年至 2018 年在代谢和减重手术认证和质量改进计划数据库中接受腹腔镜 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）的 10 至 19 岁患者。主要结局为死亡率和总体并发症。还使用多变量回归模型检查了手术趋势、再入院和再次手术率。
患者的平均 BMI 为 47.3kg/m，80.0%为 18 或 19 岁（n=4051）。有两例报告死亡。30 天内再次手术的患者占 1.1%，再入院的占 3.5%，并发症的占 1.2%。所有再入院的主要原因包括恶心/呕吐或营养耗竭（41.3%）和腹痛（16.3%）。RYGB 与更高的再入院（p=0.006）和并发症（p=0.005）几率相关。较高的 BMI 和较年轻的年龄与较差结局的发生几率增加无关。与 RYGB 相比，SG 的手术比例逐年增加，从 2015 年的 73.9%增加到 2018 年的 84.3%。
减重手术似乎对青少年风险较低，SG 已成为首选手术。鉴于安全性，需要更多关于在严重肥胖的青少年中早期考虑手术治疗的研究。
III 级。
