Surgical risks and lessons learned: Mortality following gastric bypass in a severely obese adolescent

Recent evidence highlighting the potential metabolic benefits of “early” surgical weight loss on obesity-related comorbidities has resulted in a steady increase in the number of adolescent bariatric procedures performed in the Unites States. Despite current literature describing cardiovascular disease (CVD) risk in adults undergoing bariatric surgery, there is a paucity of corresponding information related to the severely obese adolescent population. The clinical case described in this report serves as a reminder that severely obese adolescents may have subclinical CVD that has been previously unanticipated based on age alone. Although “youth” may limit the development of atherosclerotic heart disease, it does not protect against the development of other serious cardiac conditions (i.e. cardiomyopathy and microvascular disease). As with the case of other obesity-related metabolic derangements, including type 2 diabetes mellitus, obstructive sleep apnea and hypertension, the degree of CVD burden should not be underestimated in this young but unhealthy population. This case provides stimulus for important questions regarding obesity-related CVD in the pediatric population and highlights the need to establish appropriate clinical assessment algorithms and perioperative guidelines to more accurately address potential CVD risk for the severely obese adolescent population undergoing all elective surgical intervention including bariatric procedures.