title: Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis.
abstract: The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric-adolescent bariatric surgery. We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in body mass index (BMI) 1-year post-surgery and (iii) report complications, co-morbidity resolution and health-related quality of life (HRQoL). A systematic literature search (1955-2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model. In total, 637 patients from 23 studies were included in the meta-analysis. There were significant decreases in BMI at 1 year (average weighted mean BMI difference: -13.5 kg m(-2) ; 95% confidence interval [CI] -14.1 to -11.9). Complications were inconsistently reported. There was some evidence of co-morbidity resolution and improvements in HRQol post-surgery. Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents.
authors.affiliation: MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK. james.black@cantab.net
authors.forename: J A
authors.initials: JA
authors.lastname: Black
authors.forename: B
authors.initials: B
authors.lastname: White
authors.forename: R M
authors.initials: RM
authors.lastname: Viner
authors.forename: R K
authors.initials: RK
authors.lastname: Simmons
mesh_terms: D000293:Adolescent; D050110:Bariatric Surgery; D015992:Body Mass Index; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Adolescents; bariatric surgery; children; meta-analysis; obesity; systematic review