1 / 27

RATIONALE FOR BARIATRIC SURGERY IN ADOLESCENTS

RATIONALE FOR BARIATRIC SURGERY IN ADOLESCENTS. SCOPE OF THE OBESITY PROBLEM. 26% of children and adolescents aged 2 to 17 years were overweight (18%) or obese (8%) - Canadian Community Health Survey 2004

hortiz
Download Presentation

RATIONALE FOR BARIATRIC SURGERY IN ADOLESCENTS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RATIONALE FOR BARIATRIC SURGERY IN ADOLESCENTS

  2. SCOPE OF THE OBESITY PROBLEM 26% of children and adolescents aged 2 to 17 years were overweight (18%) or obese (8%) - Canadian Community Health Survey 2004 For adolescents 12 to 17 yrs - overweight rate more than doubled and obesity rate tripled over past 25 yrs

  3. SCOPE OF THE OBESITY PROBLEM

  4. SCOPE OF THE OBESITY PROBLEM 26% of children and adolescents aged 2 to 17 years were overweight (18%) or obese (8%) - Canadian Community Health Survey 2004 For adolescents 12 to 17 yrs - overweight rate more than doubled and obesity rate tripled over past 25 yrs Obesity during adolescence is the single best predictor for adult obesity

  5. Because diets, pills, lifestyle changes, and prevention strategies don’t seem to be working… WHY WOULD WE EVEN THINK ABOUT DOING SURGERY FOR OBESITY IN CHILDREN?

  6. What’s the best kind of bariatric procedure for children?

  7. What’s the best kind of bariatric procedure for children? • Malabsorptive • Restrictive

  8. What’s the best kind of bariatric procedure for children? • Malabsorptive • Restrictive • Laparoscopic band • Roux-en-Y gastric bypass • Sleeve gastrectomy

  9. OUTCOMES: ADOLESCENTS O’Brien et al. JAMA. 2010; 303(6):519-526

  10. OUTCOMES: ADOLESCENTS Treadwell et al. Ann Surg. 2008; 248(5)

  11. OUTCOMES: ADOLESCENTS

  12. OUTCOMES: ADOLESCENTS

  13. OUTCOMES: ADOLESCENTS CCHMC Bariatric Case Volume(n=144 total over 10 years)

  14. ADOLESCENT BARIATRIC SURGERY IN ONTARIO Who should be doing it, and in what kind of environment?

  15. ADOLESCENT BARIATRIC SURGERY IN ONTARIO Children are not just small adults…

  16. ADOLESCENT BARIATRIC SURGERY IN ONTARIO • Integrated multidisciplinary pediatric-oriented medical program • Pediatric medical specialties • Psychosocial support for child and family • Surgical expertise • Academic environment as part of overall pediatric obesity strategy

  17. SICKKIDS TEAM OBESITY MANAGEMENT PROGRAM (STOMP) Multidisciplinary medical/psychosocial program funded through MOHLTC Diabetes Strategy Bariatric surgery funded by MOHLTC through University of Toronto Bariatric Surgery Collaboration High Impact Strategies Toward Obesity Reduction in Youth (HISTORY) multidisciplinary grant funded by CIHR Province-wide initiative for obesity prevention and management

  18. Intake/Initial Assessment

  19. Intake/Initial Assessment Parent Group Support Adolescent Group Support Adolescent Individual Appointments Diet/Behaviour/Exercise

  20. Intake/Initial Assessment Parent Group Support Adolescent Group Support Adolescent Individual Appointments Diet/Behaviour/Exercise 3-6 Months Team Re-Assessment Ongoing support and treatment Bariatric surgery

  21. SICKKIDS EXPERIENCE SO FAR Pre-STOMP • Seven cases • 4 craniopharyngioma • 3 morbid obesity • First two: Roux-en-Y bypass • Excellent weight loss • Last five: laparoscopic band • All inflated with good initial weight loss • Two required reoperation • One removed at 2.5 years - converted to Roux-en-Y bypass • One removed at 2.0 years - converted to Roux-en-Y bypass • Weight loss results mixed

  22. SICKKIDS EXPERIENCE SO FAR Post-STOMP • Nine cases • 1 craniopharyngioma • 8 morbid obesity • First three: laparoscopic band • Excellent weight loss in 1, poor weight loss in 2 • One removed after 10 months - converted to sleeve gastrectomy • No complications • Last six: • 3 Roux-en-Y bypass and 3 sleeve gastrectomy • Excellent early weight loss • No complications

  23. SICKKIDS EXPERIENCE SO FAR

  24. ONGOING ISSUES ? • What is the best operation for adolescents? • Laparoscopic band • Potentially reversible and lower mortality • Higher complication and reoperation rate • Lower efficacy • Roux-en-Y bypass • “Gold standard” • Long term issues with vitamin deficiencies and compliance in adolescents • Sleeve gastrectomy

  25. ONGOING ISSUES • How many funded pediatric centres should there be in Ontario? • For complex medical care • For bariatric surgery • Which model is better? • Pediatric centre with help from adult surgeons • Adult centre with help from pediatric medical specialists • Transitioning to adult centres

  26. THANKS FOR YOUR ATTENTION!

More Related