Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course

In the Children's Hospital Association database from 2010 to 2022, sleeve gastrectomy has become the dominant procedure with very few bypasses performed by 2022.

The Teen-LABS study recruited 242 subjects who underwent surgery, with 219 still active and retention rate of approximately 85%.

Weight loss after gastric bypass is equivalent in teenagers and adults at approximately 26-29% at 5 years.

At 5 years post-gastric bypass, 86% of teenagers achieved diabetes remission compared to only 53% of adults.

At 5 years post-gastric bypass, teenagers had 68% hypertension remission rate compared to 41% in adults.

At 10 years post-surgery in Teen-LABS, average BMI reduction was 21% with nadir of 33% at 1 year, showing very gentle weight regain over time.

Latent class modeling at 10 years identified distinct outcome groups: approximately 11% gained weight, approximately 20% achieved 44% weight loss, with others falling in between, demonstrating significant heterogeneity.

The pharmacokinetics of alcohol are much faster after gastric bypass and probably sleeve gastrectomy, with alcohol hitting the system more rapidly.

By 8 years post-surgery, a minority of Teen-LABS patients had not experienced alcohol use, with most having some experience.

The cumulative incidence of alcohol-related problems approaches half of patients by 8.5 years post-surgery in both sleeve and bypass groups.

Normative controls adopt alcohol use earlier and at higher frequency than Teen-LABS patients based on previously published data.

Teen-LABS patients may be developmentally delayed in adopting risky behaviors like alcohol use due to social isolation related to severe obesity, potentially just delaying rather than avoiding these behaviors.

There were 14 deaths in the Teen-LABS cohort, with the first death occurring at 3.3 years post-surgery and others occurring at 7, 10, and 14 years post-surgery.

A number of the deaths in Teen-LABS were associated with multi-substance use, though this data is not yet published.

For sleeve gastrectomy, an anatomy-based approach is recommended to prevent reflux by avoiding leaving a pouch at the top and avoiding a dumbbell-shaped stomach.

Patients must take vitamins like medicines rather than supplements, which should be emphasized preoperatively and postoperatively to prevent micronutrient deficiencies.

Meg Zeller recruited approximately 81 severely obese teenagers (not as obese as Teen-LABS subjects) who did not have surgery, and preliminary comparison suggests the mortality signal may be related to severe adolescent obesity itself rather than surgery.