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The adolescent bariatric surgery: a new legitimate field but necessarily framed in the pediatric surgical activity

D. Weil*, R. Azoulay**, E. Eyssartier*, R. Coutant***, N. Bouhours***, F. Gatelais***, J. Malka°, J-L. Giniès°°, X. Deriès°°°, L. Coupris*.

* Department of Pediatric Surgery, Children Hospital, CHU Angers

** Department of Surgery, CHU Angers

***Department of Pediatric Endocrinology, Children Hospital, CHU Angers

° Unit of Pediatric Psychiatry, Children Hospital, CHU Angers

°° Adolescent Clinic, Children Hospital, CHU Angers

°°° Regional Centre of Rehabilitation and Functional Rehabilitation, Angers, France

 

ABSTRACT

Introduction: The prevalence of pediatric morbid obesity, a challenge for the Public Health, became four times higher in the last ten years in France and 75% of the obese adolescents will remain in adulthood. A growing number of adolescents escape the effectiveness of the classic medical management, hence giving rise to the question of surgical management.

Material and Methods: The bariatric surgery in adults has been used, validated, and evaluated from long time It is available for the adolescents in the USA. In France, it is not expressly prohibited, but is not validated by the HAS (High Authority of Health).

It seemed appropriate to develop inclusion and exclusion criteria and the choice of optimal surgery, with lower morbidity, that can be indicated in these adolescents. A multidisciplinary working group met once a month for two years.

Results: They created project defines: the patient inclusion and exclusion criteria in this program, the blood analysis, radiological investigations, anthropometric measuring and evaluation tests of necessary life quality, detailed schedule of the patient course, monitoring and evaluation methods, type of surgery: we chose the adjustable gastric band, a minimally invasive technique, with low morbidity and reversible. It is also a purely restrictive procedure, involving no malabsorbtive effect. We did not totally exclude the malabsorbtive techniques which were indicated in some exceptional cases.

Conclusion: This project was validated by the Ethics Committee, presented to the Court and validated by the adult bariatric surgery French experts. It entered its implementation phase. The “network” is thus formed.

 

Key words: morbid obesity, adolescent, bariatric surgery, adjustable gastric band