Lap band surgery effective for obese teens
NEW YORK (Reuters Health) - A form of weight-loss surgery called gastric banding appears safe and effective for severely obese teenagers, according to a study at one medical center.
The findings, published in the Journal of Pediatric Surgery, suggest that gastric banding could offer teenagers an alternative to more-extensive obesity surgery.
In gastric banding, or lap band surgery as it's often called, surgeons place a silicone band around the upper part of the stomach to create a small pouch. This substantially limits the amount of food a person can eat at a time and slows digestion.
Gastric banding is performed via laparoscopy, a minimally invasive technique that uses small incisions and slender instruments. Once the silicone band is in place, it's adjustable from outside the body; the band is attached to a port placed just below the skin, which allows doctors to tighten or loosen the band by injecting or extracting a salt water solution through a needle.
The procedure is less extensive and carries less risk than gastric bypass surgery. In this procedure, a surgeon staples off a section of the stomach, then attaches a lower segment of the small intestine to the new stomach pouch -- limiting not only the amount of food a person can eat, but also the body's absorption of calories and nutrients.
The U.S. Food and Drug Administration (FDA) has so far approved gastric banding only for adults, leaving gastric bypass the only surgical option for morbidly obese teens.
Only three medical centers are allowed to perform the lap band procedure on teenagers, as part of clinical trials.
Doctors at New York University Medical Center are the first to report results.
They found that none of the 53 teenagers (between 13 and 17 years old) who had gastric banding at NYU since 2001, had major complications that required hospitalization. Moreover, 18 months after surgery, the teens had lost half of their excess weight, on average.
"I think that this is an important first step toward approval by the FDA," said Dr. Evan P. Nadler, an assistant professor of surgery at NYU and the study's lead author.
However, he told Reuters Health, general conclusions can't be drawn from one study.
The results from other centers now performing the procedure on teenagers will give a better idea of how effective it is, Nadler said.
Of course, surgery is not right for every obese teen. Weight-loss procedures are only for people who are morbidly obese -- about 100 pounds or more overweight -- or who are obese and have weight-related diseases like type 2 diabetes.
One concern with teenagers has been whether they can comply with the necessary lifestyle changes after surgery. Lap band patients have to regularly see their doctor to monitor their progress and have the band adjusted.
And since the amount of food they can eat is so restricted, they have to be careful to choose nutritious food, and not the junk food teenagers favor, Nadler explained. Nine patients in his study had mild hair loss or iron deficiency, which was treated with nutrition counseling and vitamin supplements.
On the other hand, Nadler said, when it comes to keeping up with doctor visits, the teenagers have actually been more compliant than adult patients tend to be.
SOURCE: Journal of Pediatric Surgery, January 2007.
