What are the guidelines for Laparoscopic Sleeve Gastrectomy (LSG) in a 16-year-old patient?

From the Guidelines

Laparoscopic sleeve gastrectomy (LSG) can be considered for 16-year-old patients with severe obesity who have failed conservative weight loss methods, as it has been shown to be a safe and effective procedure in adolescents, with significant weight loss and improvement in obesity-related comorbidities, as reported in a study of 108 pediatric patients undergoing VSG, with a median preoperative BMI of 47 kg/m2 and a BMI reduction of 37% at 1 year 1.

Indications for LSG in a 16-year-old patient:

• BMI ≥40 kg/m² or ≥35 kg/m² with significant obesity-related comorbidities, such as type 2 diabetes, obstructive sleep apnea, or non-alcoholic fatty liver disease
• Failed conservative weight loss methods
• Presence of severe obesity and comorbidities, as emphasized by Pratt et al, which supports the medical necessity for an operation to treat obesity 1

Preoperative evaluation:

• Comprehensive evaluation, including:
  1. Nutritional assessment and counseling
  2. Psychological evaluation to ensure mental readiness and absence of untreated psychiatric conditions
  3. Endocrine workup to rule out underlying hormonal causes of obesity
  4. Family counseling and consent, as parental support is crucial
• Patient should demonstrate commitment to lifestyle changes and participate in a supervised weight management program for at least 6 months before surgery

Postoperative care:

• Close follow-up, including:
  1. Regular nutritional monitoring and supplementation (multivitamins, calcium, vitamin D, and vitamin B12), as recommended by the British Obesity and Metabolic Surgery Society guidelines, which emphasize the importance of long-term nutritional monitoring and follow-up after bariatric surgery 1
  2. Ongoing psychological support
  3. Encouragement of physical activity
  4. Annual lab work to monitor for nutritional deficiencies
• Long-term follow-up into adulthood is crucial due to the patient's young age at the time of surgery

Considerations:

• The decision to proceed with LSG in a 16-year-old should be made carefully, weighing the potential benefits of improved health and quality of life against the risks of surgery and long-term nutritional concerns
• The procedure's irreversibility and its impact on future growth and development must be thoroughly discussed with the patient and family, as highlighted by the American Heart Association's scientific statement on severe obesity in children and adolescents 1

From the Research

Guidelines for Laparoscopic Sleeve Gastrectomy (LSG) in a 16-year-old patient

• The safety and effectiveness of LSG for adolescents under 18 years old with severe obesity has been demonstrated in a study published in 2020 2.
• The study found that LSG resulted in significant weight loss, comorbidity remission, and quality of life improvement in patients under 18 years old.
• The guidelines for LSG in a 16-year-old patient may include:
  • Careful patient selection after adequate risk versus benefit evaluation by an expert multidisciplinary team.
  • A thorough evaluation of the patient's medical history, including any comorbidities or previous surgeries.
  • A discussion of the potential risks and benefits of the procedure, including the possibility of complications or the need for revisional surgery.
• Other studies have also reported positive outcomes for LSG in adult patients, including significant weight loss and improvement in comorbidities 3, 4, 5, 6.
• However, it is essential to note that LSG is a major surgical procedure and should only be performed by an experienced surgeon in a qualified medical facility.
• The patient should be closely monitored after the procedure to ensure a smooth recovery and to address any potential complications.
• Long-term follow-up is also crucial to monitor the patient's weight loss and overall health, as well as to address any potential issues that may arise after the procedure.