title: A multidisciplinary approach to the adolescent bariatric surgical patient.
abstract: OBJECTIVE
  Pediatric obesity is an epidemic in the United States. As of yet, no surgical programs specifically dedicated to the management of clinically severely obese adolescents exist. The purpose of this report was to describe the establishment and early experience of a multidisciplinary Comprehensive Weight Management Center (CWMC) in a free-standing children's hospital.
  
  
  METHODS
  With input from an ethicist, gastroenterologist, pulmonologist, endocrinologist, and adolescent medicine physician, guidelines for patient selection, evaluation, and bariatric surgical management were developed and implemented. Roux-en-Y gastric bypass (RYGBP) surgery has been performed using open and laparoscopic techniques.
  
  
  RESULTS
  The average age and body mas index (BMI) for 79 patients referred to the CWMC has been 16 years and 54 kg/m2, for boys and 17 years and 51 kg/m2 for girls. Twenty-five percent have been considered appropriate for RYGBP, 25% have not met criteria for surgery, and 50% are being evaluated. Ten patients who have undergone RYGBP had comorbidities of their obesity, including type 2 diabetes mellitus (DM), obstructive sleep apnea syndrome (OSAS), pulmonary embolism, hypertension, dyslipidemias, and depression. Clinically significant weight loss with resolution of comorbidities has occurred in all patients. Significant complications have included leak from the gastric remnant, DVT, partial roux limb obstruction, and micronutrient deficiency.
  
  
  CONCLUSIONS
  RYGBP is an effective means to treat obesity-related morbidity in the adolescent. A multidisciplinary team of pediatric specialists is needed for optimal preoperative decision making and postoperative management. Results have been satisfactory and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.
authors.affiliation: Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Inge
authors.forename: Victor
authors.initials: V
authors.lastname: Garcia
authors.forename: Steven
authors.initials: S
authors.lastname: Daniels
authors.forename: Linda
authors.initials: L
authors.lastname: Langford
authors.forename: Shelley
authors.initials: S
authors.lastname: Kirk
authors.forename: Helmut
authors.initials: H
authors.lastname: Roehrig
authors.forename: Raouf
authors.initials: R
authors.lastname: Amin
authors.forename: Meg
authors.initials: M
authors.lastname: Zeller
authors.forename: Kelvin
authors.initials: K
authors.lastname: Higa
mesh_terms: D000293:Adolescent; D000713:Anastomosis, Roux-en-Y; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010348:Patient Care Team; D013270:Stomach / Q000601:surgery