Duodenal Switch In Adolescents
Studies on Duodenal Switch in Adolescents.
Long-Term Experience with Duodenal Switch in Adolescents.
Marceau et al. Dec 2010
BACKGROUND: Severe or extreme obesity in children and adolescents
is a progressive damaging disease, increasingly requiring surgical
treatment. Timing and choice of operation are controversial.
METHOD: In the last 16 years, we performed open biliopancreatic
diversion with duodenal switch (DS) in 13 adolescents aged 15-17
years, who have been followed up for 2-16 years (mean, 10.6 years);
three with Prader-Willi syndrome (PWS) are presented separately.
RESULTS: Among the ten non-PWS children (7 girls), no deaths or
perioperative complications were reported, mean body mass index
(BMI) decreased from 55.9 +/- 14.0 to 28.8 +/- 33.7 kg/m(2)
(% excess weight loss (EWL) = 82.1 +/- 10.5%), and none have
regained weight. All comorbidities were cured except asthma,
which improved in one patient. There were two reoperations: one
for intestinal obstruction and one for post-anastomotic ulcer.
Glucose and lipid metabolism improved, while vitamin and mineral
deficiencies were mild and rare. Five of the seven girls gave
birth to 11 children, aged 2-12 years, two of whom are overweight
but not severely obese. Neurodevelopment is age-appropriate in
all 11 individuals. PWS children, aged 15-16 years, had postoperative
respiratory and infectious complications necessitating hospitalizations
of 13-22 days (versus 5.1 +/- 11.2 days in non-PWS). Weight loss
and comorbidity improvement lasted approximately 5 years, providing
improved quality of life for patient and family. One PWS patient
died from complications after reoperation for weight regain after
4 years. One was reoperated after 6 years and the third is considering
reoperation 14 years after primary DS.
CONCLUSION: The beneficial effects of DS in adolescents exceed
the risks, even in the presence of PWS.