Bariatric surgery is one of the most important treatments to treat severe obesity. Always used as a last resort, this way allows you to lose weight in an important way and in a relatively short time. However, is bariatric surgery also suitable for children and adolescents? If so, in which cases? We talk about this issue with Dr. Martina Mura, dietitian of the operating unit of Bariatric Surgery in Humanitas.
When the intervention serves to prevent other pathologies
Research published in The New England Journal of Medicine examining the case of 242 adolescents between the ages of 13-19 undergoing bariatric surgery (gastric bypass and gastrectomy sleeves) showed that surgery had significant beneficial effects in 90% of cases treated. If before the operation 98% of the subjects examined had a body weight of more than 140 kg and a body mass index (BMI) greater than 40, three years after the operation most of them weighed at least 40 kg less.
According to specialists, the intervention can also help children and adolescents to avoid the onset of complications related to obesity, such as diabetes, obstructive sleep apnea and hypertension. Further research in Saudi Arabia has also shown that obese children and adolescents between the ages of 5 and 21, undergoing bariatric surgery, had lost 62% of their excess weight within two years of the operation, preventing the onset of other diseases.
By-pass, gastric band and gastrectomy: Three different types of operations
There are several bariatric surgery techniques and it has not yet been determined which is best for children and adolescents.
With the irreversible surgical intervention of gastric bypass called Roux-en-Y, the surgeon creates a small bag in the upper part of the stomach with surgical staples and attaches this “envelope” to the central part of the small intestine. In this way, the containing capacity of the stomach is reduced and the feeling of satiety forces the patient to automatically consume a smaller amount of food. As it cannot reach the whole stomach, the food consumed is also absorbed less, with a decrease in the calories incorporated. According to more or less the same principle, but in a less invasive form, gastric band surgery also works. In this case, a band of silicone is introduced in the upper part of the stomach that limits the amount of food the patient can introduce, increasing the sense of satiety. The band can be adjusted later, depending on the patient’s needs, resulting in a very flexible instrument and, when no longer needed, it can be removed.
The most invasive intervention of bariatric surgery, however, remains laparoscopic sleeve gastrectomy. With this maneuver the surgeon reduces the size of the stomach by about 75%, making it a narrow tube that physically limits the amount of food that can be introduced. By not directly affecting the intestine, this technique does not act on the absorption of nutrients but can inhibit and reduce the production of greline, a hormone produced by the stomach and responsible for stimulating hunger. This, in the long run, contributes to weight loss.