Best practice guidelines in pediatric/adolescent weight loss surgery.
OBJECTIVE
To establish evidence-based guidelines for best practices in pediatric/adolescent weight loss surgery (WLS).


METHODS
We carried out a systematic search of English-language literature in MEDLINE on WLS performed on children and adolescents. Key words were used to narrow the field for a selective review of abstracts. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence-based models. Eight pertinent case series, published between 1980 and 2004, were identified and reviewed. These data were supplemented with expert opinions and literature on WLS in adults.


RESULTS
Recommendations focused on patient safety, reduction of medical errors, systems improvements, credentialing, and future research. We developed evidence-based criteria for eligibility, assessment, treatment, and follow-up; recommended surgical procedures based on the best available evidence; and established minimum guideline requirements for data collection.


CONCLUSIONS
Lack of adequate data and gaps in knowledge were cited as important reasons for caution. Physiological status, comprehensive screening of patients and their families, and required education and counseling were identified as key factors in assessing eligibility for surgery. Data collection and peer review were also identified as important issues in the delivery of best practice care.
Apovian
Caroline M
CM
Department of Medicine, Surgery, and Pediatrics, and Section of Endocrinology, Diabetes and Nutrition, Boston University Medical Center, 88 East Newton Street, Robinson Building, Suite 4400, Boston, MA 02118, USA. caroline.apovian@bmc.org
Baker
Christina
C
Ludwig
David S
DS
Hoppin
Alison G
AG
Hsu
George
G
Lenders
Carine
C
Pratt
Janey S A
JS
Forse
R Armour
RA
O'brien
Adrienne
A
Tarnoff
Michael
M
D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods*; D015904:Biliopancreatic Diversion; D015992:Body Mass Index; D002648:Child; D003406:Credentialing; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D016239:MEDLINE; D019300:Medical Errors / Q000517:prevention & control; D009765:Obesity / Q000601:surgery; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015431:Weight Loss