Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Sleeve Gastrectomy in Adolescents-a National Registry-Based Study

摘要

Objective Most published work on bariatric surgery (BS) in adolescents describes outcomes after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass. We compared the efficacy of LAGB and laparoscopic sleeve gastrectomy (LSG) in adolescents. Methods A National Bariatric Registry was queried for adolescents who underwent BS between June 2013 and December 2015. We collected data on weight and height at baseline and 1-year following surgery, subsequent hospitalizations, interventions, and mortality, which were compared at 30 days post-surgery and until last follow-up (maximum 4.2 years post-surgery). Mortality and hospitalization data were extracted from national databases. Results Two hundred fifty-nine adolescents (60% females) aged 12-19 years were included. Mean age and body mass index (BMI) were 17.5 +/- 1.2 years and 45.1 +/- 5.0 kg/m(2), respectively. LSG (n = 227, 87.6%) and LAGB (n = 32, 12.4%) were the most common procedures performed. LSG group achieved greater average at 1 year BMI loss compared to LAGB group (15.4 +/- 4.7 kg/m(2) vs. 10.3 +/- 5.1 kg/m(2) respectively; p = 0.0001) and higher rate with BMI < 30 kg/m(2) 1 year post-surgery (57.7% (n = 131) vs. 25% (n = 8), respectively; p = 0.0005). Males who underwent LSG reduced BMI more than their female counterparts (p = 0.0001), LSG was the strongest independent predictor for BMI < 30 after 1 year (OR = 4.1; 95% CI 1.7-9.9) followed by age (OR = 1.3; 95% CI1.0-1.6). No mortality was observed. Postoperative hospitalizations between the two groups did not differ (hazard ratio 2.4; 95% CI 0.7-7.9; p = 0.1). Conclusion Compared to LAGB, LSG is superior regarding weight loss with a similar risk of short- and long-term hospitalizations, complications, and interventional procedures. Males lose more weight following LSG.