From the Guidelines
Gastric sleeve surgery for 15-year-olds is generally considered when the adolescent has severe obesity (BMI ≥40 or BMI ≥35 with serious obesity-related health conditions) and has failed at least 6 months of structured weight management programs. Guidelines recommend that candidates should have reached physical maturity (typically Tanner stage 4 or 5), demonstrate psychological maturity with the ability to understand the procedure and its consequences, and show commitment to nutritional guidelines 1. The adolescent must have a supportive family environment and access to ongoing multidisciplinary care including psychological support. Before surgery, comprehensive evaluations by pediatric specialists, psychologists, nutritionists, and surgeons are required. The decision should be made collaboratively between healthcare providers, the adolescent, and their family, considering both the risks of surgery and the health consequences of untreated severe obesity.
Some key points to consider when evaluating a 15-year-old for gastric sleeve surgery include:
- The presence of severe obesity with a BMI ≥40 or BMI ≥35 with serious obesity-related health conditions 1
- Failure of at least 6 months of structured weight management programs 1
- Physical maturity, typically Tanner stage 4 or 5 1
- Psychological maturity with the ability to understand the procedure and its consequences 1
- Commitment to nutritional guidelines and a supportive family environment 1
- Access to ongoing multidisciplinary care including psychological support 1
Post-surgery, lifelong follow-up is essential, including nutritional monitoring, vitamin supplementation, and behavioral support to ensure proper development and prevent complications 1. This is particularly important in adolescents, who are a vulnerable group and need regular monitoring and support through growth and sexual development 1.
From the Research
Gastric Sleeve Surgery Guidelines for 15-Year-Olds
- The use of sleeve gastrectomy (VSG) for weight loss is increasing among adolescents and produces similar weight loss at five years in both adolescents and adults 2.
- Laparoscopic sleeve gastrectomy (LSG) in morbidly obese adolescents is a safe and feasible option, with short- and long-term weight loss appearing to be successful following LSG 3.
- Bariatric surgery, including VSG, is recommended to treat moderate to severe obesity, especially when complicated by comorbidities, with a body mass index (BMI) of 35 kg/m2 and associated comorbidities, or a BMI of 40 kg/m2, after failure of conservative weight loss measures 4.
Safety and Efficacy
- The complication rate after VSG ranges between 0 and 17.5%, and VSG appears to be a well-tolerated and effective procedure in adolescents 2.
- LSG has a low mortality rate, with one patient (5.6%) experiencing a 30-day perioperative complication (pulmonary embolism) in a study of 18 patients 3.
- The effectiveness of VSG on weight loss remains difficult to compare with other procedures, but it seems to be equivalent to Roux-en-Y gastric bypass (RYGB) for weight loss results and remission of type-2 diabetes (T2DM) 5.
Considerations for Adolescents
- The choice of a procedure is conditioned firstly by the benefit-risk ratio and in relation to patient-related parameters, particularly the body mass index (BMI) and co-morbidities 5.
- Long-term results are also linked to factors other than surgery and in particular patient behavioral factors, and obesity is a chronic disease that indicates the need for real long-term medical and surgical management 5.
- There is no perfect bariatric surgery, and an informed risk and benefit assessment should be made by each patient, considering the benefits and safety profile of VSG 2, 4.