Obesity in children and adolescents is defined as a BMI value greater than 20% of the 95th percentile, affecting around 6% of all adolescents in the United States (12). Moreover, adolescents with obesity, akin to the adult population, have been described as at higher risk of presenting hypertriglyceridemia, arterial hypertension, glucose intolerance, prediabetes, and, in severe cases, obstructive sleep apnea, nonalcoholic fatty liver disease, and a lower quality of life (12).
In our study, a total of 15 adolescent patients with obesity had a mean age of 17.53 (± 1.88) years were included, similar to Quinn et al meta-analysis population age (13, where 3007 teenagers were involved, whose ages ranged from 13.9 to 19.9 years old. Moreover, in the Quinn et al meta-analysis only 39 studies (59%) documented the sex distribution, which, in 63.8% of cases, involved predominantly female patients compared to 36.2% of cases involving male patients (13), similar to our population that presented an 86.7% of female patients. Furthermore, in terms of body mass index, Quinn et al reported a BMI range of 33.8 to 63 kg/m2, a range within our population's mean BMI (42.46 (± 6.17) kg/m2), corroborating our findings (13).
The prevalence of obesity-related comorbidities in children is lower than it is in adults. The baseline characteristics of the adolescents and young adults with ages ranging from 16 to 22 years old who had laparoscopic sleeve gastrectomy were reported by Tsamis et al. in their article (14). 5.4% of the 37 study participants had arterial hypertension, 5.4% had diabetes mellitus, and 10.8% had dyslipidemia. In our population, we found that the comorbidities of our patients were comparable, with 6.7% of patients having diabetes mellitus and no incidences of gastroesophageal reflux disease. Notwithstanding, none of the patients had been diagnosed with high blood pressure, and 6,7% (n = 1) of our patients had sleep apnea, different from what Tsamis et al. (14) observed.
Many surgeries for obesity and related diseases have been described worldwide, nonetheless, in terms of adolescent bariatric procedures there´s still no consensus on which procedure has to be performed, therefore, each case should be individualized. Quinn et al. (13) reported that of the 3007 adolescent patients in their meta-analysis, Roux-en-Y gastric bypass was performed in 1216 of the cases, followed by laparoscopic adjustable gastric banding (n = 1028), and laparoscopic sleeve gastrectomy (n = 665), reporting a better outcome in Roux-en-Y gastric bypass patients than other surgical procedures (13). In our study, only sleeve gastrectomy was performed, obtaining excellent results in our population. However, it seems that more evidence could be necessary in order to determine which of these bariatric procedures is better suited for this population.
Weight loss can be considered one of the cornerstones in bariatric patients follow-up. The Teen Longitudinal Assessment of Bariatric Surgery (15), enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers, who underwent Roux-en-Y gastric bypass (RYGB) (161 participants) or sleeve gastrectomy (67) in which a 29% BMI reduction in Roux-en-Y gastric bypass patients was reported and a 27% BMI reduction in sleeve gastrectomy patients after 3-year follow-up. Similarly, the AMOS Study (16) enrolled Eighty-one adolescents with a mean BMI of 45.5 kg/m2 (SD 6·1) who underwent RYGB, reporting a weight change of − 36.8 kg (95% CI − 40.9 to − 32.8) and BMI reduction of 13.1 kg/m2 after five-year follow-up. Furthermore, in our study, similar results were found, with a mean BMI reduction of 37.9% after 1 year of follow-up.
Another cornerstone in bariatric patient management is comorbidities control. The Tenn-LABS study found that remission of high blood pressure was observed in 74% (95% CI, 64 to 84) of individuals, while remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of the cases who had the condition at baseline (15). These findings confirm the quick regression of comorbidities following bariatric procedures in adolescents. In our study, we found a remission of type 2 diabetes and sleep apnea in 100% of subjects at 1-year follow-up. However, other studies, such as the meta-analysis carried out by Shoar et al. (17), found that even though the patients lost, on average, 13.3 kg/m2 of their BMI there was a weight regain of 5 kg/m2 between 5 and 6 years of follow-up, suggesting the need for a longer follow-up in the populations studied.
Ultimately, it has been demonstrated that weight loss in patients with obesity will improve GERD symptoms by lowering the intra-abdominal pressure, with better results in patients who underwent laparoscopic RYGB; however, there is still discussion regarding laparoscopic sleeve gastrectomy and its relationship to gastroesophageal reflux disease (18, 19, 20). None of the individuals in our study had a GERD-Q score that was indicative of GERD symptoms. We, therefore, requested additional GERD-Q scores during the follow-up that showed no development or progression of reflux symptoms in any of the patients.
Among the limitations of this study are the relatively small number of patients, the period of follow-up, and the scarcity of previous studies to compare our intervention. Nevertheless, this is one of the largest series reported in the literature regarding adolescent bariatric procedures, showing its feasibility, effectiveness, and safety.