Dr. Robert Cywes: Lap Band Surgery in Adolescents
How old should you be before considering gastric band surgery? Dr Cywes says patient health should be the issue not age. He recently presented the results of his clinical research at the Annual Meeting of the American Society for Metabolic and Bariatric Surgery.
“For banding, age should be less of an issue than obesity and health. The question is no longer whether banding surgery is safe or effective,” said the Robert Cywes, MD, PhD, a board-certified pediatric and general adult surgeon at the Jacksonville Weight Loss Center.
The research showed that children who underwent laparoscopic gastric banding lost more than half of their excess body weight and their complication rates were lower than those in adults.
Despite this, it is more difficult for obese teens to have access to bariatric surgery. A shortage of pediatric bariatric programs, unwillingness for insurance companies to cover these procedures, and lack of approval from the FDA combine to restrict entry into these surgical programs for obese children and teens.
Dr. Cywes’ study provides some of the strongest evidence to date showing that gastric banding is safe and effective in children. It adds to mounting evidence that gastric band surgery is a viable option for treating obese teens.
A study published recently in JAMA, showed that laparoscopic adjustable gastric banding resulted in significantly better outcomes than diet and exercise in a randomized controlled trial involving 15 teenagers. Other studies show the reluctance of medical professionals to consider bariatric surgery for young people. One survey of primary care physicians revealed that 48% would never refer an obese teenager for bariatric surgery, and 46% considered 18 as the minimum age for referral.
However, Sandra Hassink, MD, chair of the American Academy of Pediatrics’ Obesity Leadership Workgroup and director of the weight management clinic at duPont Hospital for Children Wilmington, Delaware believes the attitude toward weight loss surgery for teens may be changing.
Increasingly, pediatricians and primary care doctors look at surgery as “one of the options” for children who have failed on long-term weight loss programs, she said. Doctors need to consider each child individually and look for a program with a proven record in all aspects of weight management.
According to Dr. Cywes, age matters less than a patient’s commitment to lifestyle modifications and the support they receive from their family. “What we avow is that the age is less important than the particular patients’ mental capacity to understand the nature of the operation as well as the behavioral and lifestyle modifications required to be successful.”