Surgery for obese adolescents – gastric banding

Laparoscopic placement of an adjustable gastric band is a safe and effective alternative to laparoscopic gastric bypass surgery in the obese adolescent. The vast adult experience in gastric bypass surgery has been excellent, with weight loss in almost every case. What is unknown is the long-term impact of gastric bypass for adolescents who will require a lifetime of nutritional supplements. Patients who don’t meet nutritional requirements can have skin, growth, and developmental problems. We have already seen nutritional deficiencies in adults who do not comply with the supplement regimen.

With gastric banding, patients don’t have the same type of nutritional problems because there is no rerouting of the gastrointestinal tract to reduce absorption. Both procedures have low complication rates, but adverse events that do occur during bypass surgery are significant. In adults, the procedure has a mortality rate of 0.5% and a morbidity rate of 2%-5%. Gastric banding complications are slightly more common but are usually less severe; the mortality rate is about 0.01%.

Unlike gastric bypass, banding does not involve cutting part of the stomach. Instead, the adjustable silicone band is placed around the proximal stomach to restrict food entry. The band can be tightened for more weight loss or loosened in cases of pregnancy or when weight is being shed too rapidly. Also on the plus side for gastric banding in adolescents is the ability to reverse the procedure. Removing the gastric band requires an operation, but it is a much more straightforward procedure than trying to reverse gastric bypass surgery. And reversibility is not just about patients who aren’t adapting after surgery. If in 5 years the perfect medication comes along for safe and healthy weight loss, there is a way to remove the band.

Finally, we tend to favor the adjustable gastric band because of its effectiveness. The literature shows that gastric bypass patients will lose 50%-60% of their excess weight in the first year, compared with about 40%-45% with the gastric band. But by 3 years, the total weight loss with either the band or gastric bypass is about the same. Over time, patients get the same advantages of significant weight loss and reduced com-morbidities associated with obesity.

Since weight loss is more gradual, patients must be counseled to have realistic expectations. It is a tool to help them lose weight; it won’t work for them if they are in a hurry to shed pounds or unwilling to modify their eating habits. The banding approach also requires careful and frequent follow-up, which can be difficult for patients who live far from the facility.