Bariatric Surgery for the Severely Obese Adolescent

Evaluation of the severely obese patient for surgery involves multiple factors, including the overall maturity of the patient; joint discussions with the patient and his or her family; a complete medical evaluation; evaluation by a child psychologist or psychiatrist; and a minimum of 6 months of private, interdisciplinary, multifaceted lifestyle preparation. Surgical options are restricted to severely overweight adolescents without endocrine disorders who have achieved puberty and have failed more conservative therapies. The Roux-en-Y gastric bypass is the most commonly performed procedure in adolescents, but the laparoscopic adjustable gastric band procedure is growing in popularity. Postoperatively, patients are evaluated 2 weeks after surgery and then every 1 to 2 months for the first postoperative year; every 2 months to 6 months in the second year, depending on the individual case; and then annually for life. A careful diet plan backed by continuing family support is essential. Short- and long-term complications are similar to those seen in adults, and include bowel obstruction, bleeding, blood clots, nausea, gallstones, hernia, and vitamin and iron deficiencies.