Pediatric bariatric surgery: the clinical pathway.
OBJECTIVE
Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution.


METHODS
Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only.


RESULTS
Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients.


CONCLUSIONS
Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.
Department of Surgery and Obesity Chair, College of Medicine, King Saud University, 84147, Baabda, Riyadh, 11671, Saudi Arabia, qahtani@yahoo.com.
Aayed R
AR
Alqahtani
Mohamed O
MO
Elahmedi
D000293:Adolescent; D016497:Adolescent Health Services; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D015897:Comorbidity; D019091:Critical Pathways; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult