Surgery for obese adolescents – gastric bypass

Laparoscopic bypass surgery is the best option for treating most obese adolescents, as it is for most adult patients. Experience with gastric bypass goes back 25-30 years. Banding has been shown to be successful for about 10 years, but data beyond that are not available, and the procedure is successful in only about 75%-80% of patients, versus 90%-95% with the bypass.

Gastric bypass creates hormonal changes that not only control hunger and create  satiety but also benefit common co-morbidities of obesity such as diabetes and sleep apnea. Gastric banding has less of an impact on these co-morbidities. Data from the Swedish Obese Subjects study show that greater weight loss is sustained at 10 years with gastric bypass than with conventional obesity treatment or gastric banding. For severely overweight adolescents, behavior modification and diet should be the first approach, but when this doesn’t work would favor a Roux-en Y gastric bypass.

The operative risk of gastric bypass, while low, is higher than with the banding procedure. Yet severe obesity is the greatest risk to adolescents, and the operative risks pale in comparison. The mortality risk of remaining obese can be as high as 1% per year, while the risk of dying from surgery is 0.05%-0.5% for these two operations. Reversibility is often an argument made in favor of gastric banding. In fact, although gastric banding can be reversed in most cases, when significant surgical scarring or erosion of the band into the stomach occurs, surgeons can’t repair the damage, and this may prevent reversal. While it is difficult to reverse a gastric bypass procedure, it can be done in most cases.

Another consideration is the lifespan of the implantable device. We worry about the gastric band wearing out and breaking. If the patient needs another operation after 10 or 15 years to replace the band, that increases risks. Proponents of gastric banding say that by the time the band wears out, there could be an effective weight loss drug on the market that would replace these invasive surgical approaches. While we are hopeful that this will be the case, it’s  a gamble to assume that researchers  will find a medical cure for obesity.

Overall, both procedures are safe and effective options. Physicians need to consider the individual patient when choosing a surgical approach. In most cases, we favor gastric bypass, but certain adolescents are better suited to a gastric band. For example, a severely obese teenage girl with polycystic ovarian syndrome and diabetes is an excellent candidate for gastric bypass. But a girl who has a lower body mass index and no comorbidities might be treated with a gastric band.