Recent ASMBS guidelines suggest that developmental delay (DD) is not a contraindication to laparoscopic sleeve gastrectomy (LSG) in adolescents with obesity. While the data are sparse, there is no evidence of increased complications in this group. Nevertheless, medical, behavioral, and ethical factors may impede optimal bariatric care. We report preliminary outcomes of a multidisciplinary strategy to manage this population with LSG.
This pilot program began in January of 2018 to use LSG as a management option for adolescents with obesity and DD. A retrospective review was performed of patients enrolled to date to describe presenting features and outcomes.
Between January of 2018 and May of 2019, 6 patients with obesity and DD received LSG (Table 1). Five (83%) were male with median age of 15.5 years (range 11-22 years). Developmental conditions included autism (n=2), Down’s syndrome (n=1) and other (n=3). Five patients (83%) presented with medical (not obesity-related) and psychiatric comorbidities. Three patients (50%) received ethics consultation preoperatively to assess surgical assent. Median initial BMI was 47 kg/m2 (range 41-60 kg/m2). Six months postoperatively, median BMI was 44 kg/m2(range 42-45 kg/m2), median percent excess BMI loss was 41% (range 40-41%) and median percent total weight loss was 18% (range 12-22%). One postoperative complication of seizure activity in a patient with a known seizure disorder resolved. All patients have been compliant with dietary changes and medications.
Adolescents with obesity and DD may be successfully managed with LSG. Multidisciplinary management and ethics consultation facilitate optimal bariatric care.