SURGICAL MANAGEMENT OF OBESITY IN ADOLESCENCE

Abstract

Obesity is really a medical health problem, not only from a cosmetic view but more importantly is a true pathological metabolic disorder affecting all systems of the human body either organically or psychologically. Obesity is the second most common cause of death after smoking from modifiable behavioral risk factors. The severity of obesity is identified by body mass index (B.M.I) calculated as weight in kilograms divided by height in meters squared, so patients are classified into: overweight, obese and morbidly obese. Morbid obesity, which leads to pathological disorders, in the adolescence is considered to be the most serious and most problematic compared with other life periods, as the adolescent morbid obesity affect physical, social, economic and psychological states in short and long term. A lot of etiological factors sharing in occurrence of morbid obesity as: Diet–Lifestyle‐Genetic and Hormonal factors. There are many modalities in management of adolescent morbid obesity starting from Diet programs, Physical exercise, Behavioral modification, Anti‐obesity drugs ending by the role of Surgery. Weight loss surgery (W.L.S) or Bariatric surgery is considered the ideal solution of morbid obesity in all life stages including extremes of age and adolescence period. All the modalities of bariatric surgery have shown much better results, in terms of weight loss, when compared to more conservative approaches; The procedures, although invasive, have demonstrated that they diminish co-morbidities, and carry a low risk and a low rate of complications. Bariatric surgical procedures are classified into main three classes;i.e. gastric restrictive operations e.g. (LABG) Laparoscopic Adjustable Gastric Banding, (S.G) Sleeve Gastrectomy, (V.B.G) Vertical Banded Gastroplasty, those that reduce food uptake from the digestive tract i.e. malabsorbtive operations e.g. Bilio‐Pancreatic Diversion (B.P.D) with Duodenal Switch (DS) and combined procedures i.e. malabsorbtive/restrictive operations e.g. Roux‐en‐Y gastric bypass.

The best modality of surgery and the best time for it to be performed still depend on studies with a high number of adolescent patients and long term follow-up; as the number of cases increases, there has been a tendency to indicate surgery at younger age groups. In Conclusion Bariatric surgery offers an ideal preventable tool of long‐term physical, social, economic and psychological disorders resulting from adolescent morbid obesity.