Laparoscopic adjustable gastric banding in adolescents

Obesity in children and adolescents has increased to epidemic proportions since the late 1990s. The most recent estimates show that 16% of American children and adolescents are obese, and the prevalence is climbing. Obesity is clearly affecting the health of youngsters as well, particularly those with severe obesity. Due to the limited effectiveness of conventional weight management efforts, increased exploration of more drastic interventions has occurred, including bariatric surgical procedures. Many bariatric procedures have been developed since the 1970s including the intestinal bypass, horizontal and vertical gastroplasty, Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and most recently, electrical gastric pacing (Deitel and Shikora 2002; Livingston 2002). These operations can restrict intake, interfere with the absorption of ingested nutrients, alter physiologic satiety signals, and alter gastric motility. The goals for any weight-loss procedure are: (1) to provide durable, longterm weight reduction, (2) change eating behaviors, (3) treat obesity-related comorbidities, and (4) decrease the incidence of death attributable to obesity. Minimally invasive options have been developed for all of the modern weight-loss procedures (OBrien et al. 1999; Schirmer 2000). While RYGBP has been most widely used in the USA because of the excellent longterm weight loss (Pories et al. 1995), the LAGB is gaining acceptance in the USA as an effective procedure with a favorable safety profile (Ren et al. 2002). These features are important when considering surgical weight-loss options for extremely obese adolescents. The LAGB effectively allows adolescents to lose a significant amount of excess body weight and most comorbidities are reduced or resolved (Dolan et al. 2003). This chapter specifically focuses on: (1) the perioperative evaluation and preparation of the patient and family once the decision for surgery has been made, (2) the technical aspects of LAGB, (3) adolescent results of LAGB, and (4) the postoperative management of the adolescent LAGB patient.