Pediatric bariatric surgery

Overview 

Pediatric bariatric surgery, also known as adolescent weight loss surgery, is a procedure designed to help teens and young adults achieve a healthier body weight by altering how their bodies absorb and process calories from food. This surgery is typically recommended by healthcare providers when an adolescent’s weight poses a significant risk to their health. While still relatively uncommon, pediatric bariatric surgery is gaining wider acceptance as a safe and effective treatment option for teenagers with severe obesity.

Reasons for undergoing the procedure  

Adolescent weight loss surgery enables faster weight loss compared to relying solely on diet and exercise. Achieving and maintaining a healthy weight through this surgery can help treat or prevent serious medical conditions such as: 

• Diabetes.
• Sleep apnea.
• Liver disease.
• Bone and joint pain.
• Depression and social anxiety.
• Hypertension, or elevated blood pressure.
• Hypercholesterolemia, or high cholesterol.
• Hormonal disorders such as polycystic ovarian syndrome. 

Before the procedure  

Before suggesting bariatric surgery, your provider will perform a physical examination and request several tests to evaluate whether you are a suitable candidate for the procedure.  

Blood tests will be conducted to assess:  

• Blood glucose levels and A1C, to look for Type 2 diabetes.  
• Cholesterol.  
• Complete blood count (CBC).  
• Liver function.  
• Nutritional deficiency.
• Pregnancy.
• Thyroid function.

You may also need to undergo a sleep study (polysomnography) to assess for sleep apnea. Additionally, an X-ray or bone mineral density test will be performed to ensure that your skeletal system is adequately mature for bariatric surgery.

As part of your preparation, you’ll meet with a counselor to help you mentally and emotionally prepare for the surgery, recovery, and ongoing weight management. You will also consult with a dietitian and a physical therapist or exercise physiologist to create a customized nutrition and exercise plan to support your long-term success.

Your doctor may recommend, and your insurance could require, regular monthly meetings with your medical team for at least six months before the pediatric bariatric surgery. 

During the procedure  

These surgeries are performed under general anesthesia.  

• Gastric Sleeve Surgery (Sleeve Gastrectomy): This procedure involves removing a portion of the stomach and shaping the remaining tissue into a narrow tube or “sleeve.” The new, smaller stomach not only limits the amount of food you can eat but also decreases the production of hunger hormones.  
• Gastric Bypass Surgery (Roux-en-Y Gastric Bypass): In this surgery, the stomach is divided into two sections, creating a small pouch at the top. The pouch is then connected directly to the small intestine, allowing food to bypass a significant portion of both the stomach and small intestine. As a result, the pouch can hold much less food than the original stomach, and bypassing part of the small intestine reduces the absorption of calories and nutrients from the food you eat.

Typically, pediatric bariatric surgery requires a few hours to complete. While the gastric bypass takes longer, the sleeve takes less time. After that, you are taken to a recovery room, where you are observed by your doctor while you come out of anesthesia. 

After the procedure 

After juvenile weight loss surgery, you will typically spend one to two days in the hospital. During this time, your doctor will begin a liquid diet for you. Once you adapt to this, they will gradually introduce pureed (blended) foods. Transitioning to solid foods may take up to six weeks. 

Risks 

The hazards associated with many other surgical procedures also apply to adolescent bariatric surgery. Among the potential issues are:  

• Infection.
• Bleeding.
• Blood clots. 
• An allergy to anesthesia.

Adolescent weight loss surgery, however, raises certain other issues as well. It could take some time for your body to become used to eating much less food. When your stomach can no longer hold its previous contents, you can feel any of the following symptoms:  

• Pain. 
• Dehydration.
• Low blood glucose.
• Low bone density.
• Nausea and vomiting.
• Headaches from hunger as you adjust to using fewer calories.Heartburn.
• Dietary inadequacies that supplements may help with. 

Outcome  

Most teenagers can return to school about two weeks after bariatric surgery. However, your doctor may advise limiting physical activities—such as gym class, sports, and heavy lifting—for up to a month to ensure proper healing. It’s also crucial to avoid pregnancy for at least 18 months following the surgery.  

Regular follow-up with your doctor is essential for monitoring your physical health, nutrition, and emotional well-being. If significant weight loss occurs, your doctor may recommend a consultation with a surgeon for excess skin removal and body contouring.  

While weight loss surgery can be highly effective for young adults and teens, it is not a guaranteed solution for maintaining weight loss. Success relies on a long-term commitment to exercise and healthy eating. The surgery serves as a tool to facilitate dietary changes and enhance the effectiveness of physical activity.  

Research indicates that 60% of adolescents lost 20% or more of their body weight and maintained that loss for at least five years. Recent studies have also shown that bariatric surgery can effectively reduce body weight and manage related complications for up to nine years, with ongoing research aimed at providing further insights into long-term outcomes.