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Lap-Band Surgery for Adolescents NYU Medical Center Program for Surgical Weight Loss George Fielding, MD Associate Professor of Surgery Evan P. Nadler, MD Assistant Professor of Surgery, Director of Minimally Invasive Pediatric Surgery Christine Ren, MD Assistant Professor of Surgery

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Lap-Band Surgery for Adolescents

NYU Medical Center Program for Surgical Weight Loss

George Fielding, MD

Associate Professor of Surgery

Evan P. Nadler, MD

Assistant Professor of Surgery, Director of Minimally Invasive Pediatric Surgery

Christine Ren, MD

Assistant Professor of Surgery


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NYU Adolescent Bariatric Experience

Three Phases:

  • Brisbane, Australia (1998-2004) n= 41

  • Off-label experience (2002- 4) n= 41

  • FDA Study (2005) n=17


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Brisbane n=41 17.1 YRS ( 12-19)

Y No. Wt (lbs) BMI % EWL

0 41 275 43

1 21 210 32 50

2 18 200 29 69

3 16 200 29 70

4 5 193 29 63

6 3 171 27 65


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Teenagers ? Success

  • 80% had lost at least 50% of their excess body weight at 36 months

  • 80% had a BMI < 30 kg/m2 at 36 months

  • Visits in 2 yrs: 12.3 (5 - 22)


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NYU Bariatric Program

  • Largest lap- band experience in world

  • Dedicated to long term follow-up

  • Multi-Disciplinary

  • In-house Nutritional Team

  • Includes Pediatric Surgeon

  • Psych care at NYU Child Study Centre


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Lap- Band in AdolescentsDemographics n= 58

  • Gender

    Female: 46

    Male: 12

  • Age

    13yrs 5

    14-17 yrs 40

    18-19 yrs 13

  • Race

    Caucasian 50

    Hispanic 5

    African American 3



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Pre-Op Weight and BMI

  • Pre-OP and OP Data


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Lap BandPeri-operative complications

  • All patients discharged <24 hrs

  • Increasing use of same-day approach

    Complications

  • Mortality 0

  • PE 0

  • Acute re-op 0

  • Acute readmission <30 days 1 (perforated appendicitis)







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Lap – Band ComplicationsReflux (GERD)

  • All patients have yearly esophagrams

  • 4 / 58 patients have complained of reflux symptoms, typically in the evening

  • All 4 then had diagnostic esophagrams

  • Findings: 2 true slips

    2 concentric dilatations ( hiatal hernia)

    Outcome: 2 patients hiatal hernia repair

    2 patients repair slipped band

    All 4 done as day- cases

    All 4 resolved, off treatment, band re-adjusted, ongoing weight loss


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FDA STUDY:

STUDY TITLE:

  • A prospective, open-label study to evaluate the safety and efficacy of Lap-Band® Adjustable Gastric Band (LAGB®) Operations in the Treatment of Morbidly Obese Adolescents (Ages 14-17)

    STUDY OBJECTIVES:

  • to demonstrate the safety and efficacy of the use of the LAP-BAND® System in the morbidly obese adolescent population in the United States, and therefore provide these individuals with a significantly less morbid and reversible surgical option for weight loss.

  • to assess the status of co-morbidities and changes in quality of life from baseline.


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FDA Trial (Age 14-17)

  • Patients enrolled : 22

  • Patients had surgery : 17

  • Gender

    Female: 13

    Male: 4

  • Age

    14 years old: 4

    15 years old: 4

    16 years old: 5

    17 years old: 4

  • Race

    Caucasian: 10

    Hispanic: 5

    African American: 1

    Native American: 1


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N:17

Pre-OP and OP Data






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Lap Band Surgery for Adolescents

Conclusions

  • The surgery is safe

  • The Lap- Band delivers effective weight loss for adolescents


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