Recent studies suggest that obesity and overweight even in children less than two years of age is associated with early morbidity. Overweight and obese toddlers (<2 years of age) — as compared to normal weight children — were observed to have more admissions, as well as a larger number of repeated admissions; development delays; and had high incidence rates of respiratory morbidity such as snoring, asthma and stridor.
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A report was published recently in the International Journal of Surgery Case Reports on the laparoscopic sleeve gastrectomy (LSG) of a two-and-half-year-old morbidly obese child. Sleeve gastrectomy is an accepted technique in bariatric surgery for reducing obesity. It is not reversible. Recent reports indicate it to be effective even in children, but it has not been tried in very young children.
The report abstract follows:
We report here a case of a 2 and half years old child subjected to LSG for his morbid obesity and associated obstructive sleep apnea and bowing of legs. LSG was performed after investigations ruled out hereditary or genetic causes of obesity. The procedure was well tolerated without any complications and 2 months post-surgery, the obstructive sleep apnea decreased substantially. The child was followed up for two years. At the last follow up BMI was drastically reduced from a pre-surgical value of 41.1kg/m2 to 24kg/m2 at 24 months post-surgery.
Prior to our report the youngest child to undergo sleeve gastrectomy was a 5 year old from Saudi Arabia. We observed LSG to be safe and effective in reducing obesity and related co morbidities in a two and half year's old child.
The results suggest that LSG can be a safe and effective alternative for weight control in morbidly obese children even of less than 3 years of age. However more studies and long term follow up is essential for monitoring the growth and development of children subjected to LSG.
Bariatric Surgery in Children
According to a study published in the Annals of Surgery, severely obese children with co morbidities and those who do not respond to lifestyle changes and pharmacotherapy benefit from bariatric surgery. This claim is based on a study of 108 obese children and adolescents ages 5-21 who underwent LSG in Saudi Arabia.
Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are the two main surgical procedures which have been used in pediatric obesity. RYGB is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided. LAGB has not been approved by FDA for use in adolescents, and, therefore, should be considered investigational.
Finally, sleeve gastrectomy, another type of weight loss surgery, which has gained significant appreciation in adults, should be also considered investigational; existing data are not sufficient to recommend widespread and general use in adolescents.
There are currently three main treatment modalities for childhood obesity:
a) Lifestyle modifications, which include exercise, diet, counseling, and combination of these.
b) Pharmacotherapy, which may have a role in a select group of overweight adolescents.
c) Bariatric surgery. Bariatric surgery has been suggested to result in sustained and clinically significant weight loss in pediatric patients with morbid obesity, but with a potential for serious complications.
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Published On: September 27, 2013