Long-Term Follow-Up Is Essential to Assess Outcome of Gastric Banding in Morbidly Obese Adolescents: A Retrospective Analysis

Abstract

Background: Adolescent obesity is rapidly becoming more prevalent and is associated with chronic health conditions and psychosocial morbidity. Lifestyle intervention is often ineffective in morbidly obese adolescents, and bariatric surgery is gradually becoming an accepted treatment. However, little is known about long-term results.

Methods: Hospital charts of patients who had undergone gastric banding more than 5 years ago at an age of 18 years or younger, were retrospectively analyzed. Weight loss, complications, reoperations, and comorbidity reduction were assessed as well as health status, food behavior, and personality.

Results: BMI loss in 10 adolescents was 10.7 kg/m2 (-0.9 to 12.9 kg/m2) after a median follow-up of 64 months (52-84 months); the major part of weight loss occurred after the first year. In 4 patients the gastric band was removed after 3.5-5.5 years. Two out of 3 patients effectively lost weight after conversion to a bypass type procedure. One patient is maintaining a stable healthy weight after band removal.

Conclusions: Laparoscopic adjustable gastric banding in morbidly obese adolescents had a failure rate of 40%, but was a successful therapy in the other 60% without major adverse events. Follow-up longer than 36 months was crucial for optimal evaluation of weight loss and reoperation rate.

Fig. 1

Weight loss graphs expressing excess BMI loss, BMI loss, BMI, weight and weight loss in the first year and at the end of follow-up with in situ LAGB. True median values are in the dotted boxes. OR = time of procedure. 6M = 6 months follow-up. 12M = 12 months follow-up. END = last visit with gastric band in situ * p < 0.05 ** p < 0.01 compared to OR.

Fig. 2

Subscale scores on the SF-36 quality of life questionnaire at the end of follow-up. Median values are presented in the dotted boxes. The red dotted bars indicate the Dutch population mean. The blue dashed bars indicate one standard deviation below mean. PF = Physical functioning; RP = role physical; BP = bodily pain; GH = general health; VT = vitality; SF = social functioning; RE = role emotional; MH = mental health.

Fig. 3

Subscale scores on the EDE-Q and NVE. Baseline (BL) scores are compared to end of follow-up, with or without gastric band in situ (END). The red dotted bars indicate the Dutch population mean. The blue dashed bars indicate one standard deviation above or below the mean.

Fig. 4

Neuroticism, social anxiety and dominance as scored on the NPV and/or NPV-J before surgery (BL) and at the last follow-up visit, with or without gastric band in situ (END). *END versus BL p.