From the Guidelines
Gastric sleeve surgery for a 15-year-old should only be considered after a comprehensive evaluation and when specific guidelines are met, including a BMI of 40 or higher, or a BMI of 35 with serious obesity-related health conditions, as recommended by recent guidelines 1. To be eligible for gastric sleeve surgery, the adolescent should have a BMI of 40 or higher, or a BMI of 35 with serious obesity-related health conditions like type 2 diabetes or severe sleep apnea. Before surgery is considered, the teen must demonstrate at least 6 months of supervised weight management attempts without success, as suggested by a multicenter study of gastric bypass and sleeve gastrectomy 1. The adolescent must be physically mature (generally Tanner stage 4 or 5) and psychologically stable with good understanding of the procedure and lifelong lifestyle changes required. A multidisciplinary team evaluation is essential, including pediatric specialists, surgeons, nutritionists, and mental health professionals, to ensure the teen is a suitable candidate for the procedure, as agreed upon by several multidisciplinary panels 1. The teen must show commitment to post-surgical follow-up care and have strong family support, as the procedure permanently reduces stomach size by about 80%, requiring lifelong vitamin supplementation and dietary changes. While gastric sleeve can be effective for severe adolescent obesity, it's considered only after other interventions have failed and when the benefits clearly outweigh the risks, as demonstrated by good outcomes and a favorable complication rate in a multicenter study 1. Key considerations for gastric sleeve surgery in adolescents include:
- Physical maturity: generally Tanner stage 4 or 5
- Psychological stability: good understanding of the procedure and lifelong lifestyle changes required
- Family support: strong support system at home
- Multidisciplinary team evaluation: essential for ensuring the teen is a suitable candidate for the procedure
- Post-surgical follow-up care: commitment to lifelong vitamin supplementation and dietary changes.
From the Research
Gastric Sleeve Guidelines for 15-Year-Olds
- The safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) for adolescents under 18 years old with severe obesity have 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.
- Another study published in 2014 found that laparoscopic sleeve gastrectomy may be advantageous for late adolescent patients, as it involves neither foreign body placement nor lifelong malabsorption 3.
- A review published in 2020 summarized the most recent updates in the field of metabolic and bariatric surgery, particularly vertical sleeve gastrectomy (VSG), in adolescents, and found that VSG is a well-tolerated and effective procedure in adolescents 4.
Key Considerations
- Careful patient selection after adequate risk versus benefit evaluation by an expert multidisciplinary team is essential for LSG in adolescents 2.
- The complication rate after VSG ranges between 0 and 17.5%, and regular check-ups are vital to ensure a positive outcome and early detection of possible issues 4, 5.
- Reflux and weight regain are common issues with SG in long-term follow-up, and patients should be selected carefully for this procedure 5.
Surgical Technique and Outcomes
- LSG is mainly a restrictive procedure consisting of the resection and removal of a major part of the stomach, which has an additional impact on hormones such as Ghrelin and Glucagon-like Peptide 1 5.
- The surgical technique itself, including positioning of the patient, positioning of the trocars, and related tips and tricks, is crucial for a successful outcome 5.
- The outcomes of SG include weight loss, remission of comorbidities, and quality of life improvement, with a low risk of malnutrition 5.