Risks of bariatric surgery lessened by new guidelines

A defined clinical pathway that leads to fewer complications and does not result in stunted growth for children who need bariatric surgery, has been developed by Saudi researchers. 

A 2013 survey showed 23% of Saudi school children are overweight with 9% classified as obese. Among pre-school children, about 15% are overweight and 6% obese. The Saudi Journal of Obesity reported that local studies show a rising trend of obesity.

Bariatric surgery is usually considered when a child is not responding to alternative weight management programs. 

Now researchers from King Saud University (KSU) in Saudi Arabia are proposing a standardised weight management (WM) protocol that includes bariatric surgery within a clinical pathway for optimum results. 

“We have strict criteria to offer bariatric surgery to children and adolescents regardless of their age, which include Body Mass Index (BMI) of 35 with obesity related co-morbidities, or BMI of 40,” researcher Aayed Alqahtani from KSU, tells Nature Middle East. “For younger children BMI is not very accurate and we substitute it with what is called BMI percentile in which we require the patient to be more than 99th – or super obese – to be eligible for surgery even if their absolute BMI is less than 35,” he adds. 

Between March 2008 and July 2014, Alqahtani has tracked the progress of around 659 obese children and teenagers who underwent surgery through the pathway with a clearly defined weight management protocol and guidelines already in place in Alqahtani’s practice. 

The standardised clinical pathway includes actions and interventions that must be carried out by all healthcare workers at each contact point during a patient’s care including preoperative, intraoperative, postoperative and follow-up.

Of the patients under scrutiny, 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Only 12 patients suffered from postoperative complications, and Alqahtani says those were mostly minor complications seen with any procedure. He says the only complication specifically related to bariatric surgery was a vitamin deficiency that was safely corrected. None had any lasting complications.

It is risk to life that determines necessity for the bariatric procedures, says Alqahtani. Diabetes, sleep apnea, hypertension, psychological effects of obesity and other problems all cause drastic health problems for children, leading to frequent hospital visits, organ damage, and early death.

More than 90% of co-morbidities suffered by children and adolescents before undergoing surgery were cured or improved, not just due to the weight loss but also because of “overall improvement in the metabolic status of patients,” says Alqahtani.  

Patients were of different age groups but age did not factor in recovery. 

“However, children with Prader-Willi syndrome, a genetic condition that causes severe early-onset obesity with significant food seeking behaviour, had a tendency to regain some of the weight they lost,” Alqahtani says. 

“Nevertheless, none of the 21 Prader-Willi children in our centre had a recurrence in any of the co-morbidities that they suffered before the surgery,” he adds. 

Future research will look at the risks associated with bariatric surgery in patients aged 14 years old and under.  

Independent researcher Kurt Widhalm from Academic Institute for Clinical Nutrition in Vienna, who was not involved in the study, says that “if the criteria for the selection of the patients who should be operated are met very carefully and if there is a strict follow-up observation, then the results are good.” 

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