9 Years after the first laparoscopic adjusted gastric banding (LAGB) in adolescents: the Portuguese experience.

Introduction: Children all over the world are increasingly becoming overweight and obese. The experience with adults has demonstrated that surgery is the only effective way of achieving sustained weight loss in obese patients. Simultaneously, it has been proposed that bariatric surgery in the adolescent period would be a more effective treatment for childhood-onset extreme obesity rather than delaying surgery for extremely obese youth until adulthood. Nevertheless, the optimal surgical option for both adults and adolescents has yet to be established. The aim of our study was to evaluate the results of 9 years of laparoscopic adjusted gastric banding (LAGB) performed in our hospital for obesity-associated comorbidities (OAC), weight loss and surgical morbidity.

Methods: A prospective study of all patients who underwent LAGB at our hospital between July 2001 and May 2010 was carried out. Patient selection was by a multidisciplinary team and based on the "IPEG Guideline for the Surgical Treatment of Extremely Obese Adolescents". Data were reviewed retrospectively.

Results: 14 patients underwent LAGB (10♀; 4♂; average age: 16 years). Preoperative BMI ranged between 41.4 and 54.6 kg/m (2). Prior to surgery, 8 different OACs were identified. 6 months later, 4 types of OAC had resolved completely and the other 4 had improved, and the improvement was maintained over time. The average excess weight (EW) loss increased from 25.7 to 48.2% at 6 and 36 months of follow-up, respectively (10 patients). At 60 and 106 months of follow-up it was 41.5% (5 patients) and 31.8% (1 patient), respectively. There were no complications arising from the surgery itself. Long-term complications were few and easily managed.

Conclusions: LAGB seems to be a good option to treat obese adolescents, as it is a minimally invasive procedure that does not radically change the patient's anatomy and is associated with minimal morbidity. It leads to a sustained improvement/resolution of OAC, and although weight loss is not continuous, it is maintained over time.