title: Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy.
abstract: BACKGROUND
  Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents.
  
  
  METHODS
  Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions.
  
  
  RESULTS
  The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively.
  
  
  CONCLUSIONS
  LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.
authors.affiliation: Department of Surgery and Obesity Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address: qahtani@yahoo.com.
authors.forename: Aayed R
authors.initials: AR
authors.lastname: Alqahtani
authors.affiliation: Department of Surgery and Obesity Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mohamed O
authors.initials: MO
authors.lastname: Elahmedi
authors.affiliation: Department of Surgery and Obesity Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Awadh
authors.initials: A
authors.lastname: Al Qahtani
mesh_terms: D000293:Adolescent; D050110:Bariatric Surgery / Q000379:methods*; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000601:surgery; D050171:Dyslipidemias / Q000150:complications / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: Bariatric surgery; Children; Co-morbidity resolution; Pediatric; Sleeve gastrectomy