Bariatric surgery has improved remission of DMII and HTN when performed...

Hey, this is Alexander Gibbens from Akron Children's Hospital, and here's your video review. The article that I'm going to be discussing today came from the New England Journal of Medicine and is entitled: "Five-year outcomes of gastric bypass in adolescence as compared with adults". This study was a result of the Teen Labs Consortium, with Dr. Thomas Inge as the first author, and Dr. Michael Helmrath as the senior author. We already know that bariatric surgery has significant health benefits in adult patients. What this study was interested in evaluating was whether those outcomes were any different when surgery was done at an earlier age. Therefore, they looked at all patients in the Teen Lab study, so patients who had surgery as adolescence, and compared them to patients in the Lab study, so patients who had surgery as adults. For the patients of the Lab study, they were looking at the subset that identified as obese as adolescence. As part of both of these studies, patients were evaluated at five years. What they found was that there was no difference in terms of weight loss between the two groups. It was about 25% to 30% for both arms. However, there was a significantly higher rate of remission for type two diabetes and of hypertension when surgery was done in the adolescent group. Specifically, for type two diabetes, they found that there was an 86% remission in the adolescent group versus 53% in the adult group. For hypertension, they found a 68% remission in the adolescent group versus a 41% remission in the adult group. However, there were some downsides to earlier surgery. Specifically, they found that there was a higher rate of low ferritin levels in the adolescent group at 48% as compared to the adult group at 29%. The authors hypothesized that this may be due to decreased compliance amongst adolescent patients in taking their multivitamins, and therefore this is something that should be watched for in post-operative visits. Additionally, they found that there was a higher rate of abdominal reoperations in the adolescent group, which the authors felt may be due to pediatric bariatric surgeons being more willing to take their patients back to the operating room. Overall, this was a fantastic study that really highlighted the benefits to doing bariatric surgery at an earlier age, but also emphasizing that there are some different challenges for the pediatric group as compared to the adult group. Alex, thanks for reviewing this paper. This was clearly a very important paper. I think this is a real sentinel article. Let me see if I got this right. So it compared all children that were identified as having obesity in adolescence, but one group had surgery as an adolescent, and the other waited until they were an adult. Right. Mhm. So in the group that had their gastric bypass done as an adolescent, they found a substantial difference in sustainable remission of diabetes and hypertension in the adolescent group compared to the adult group. Is that right? Right, yeah, there was remission in both groups, but it was significantly higher in the adolescent group. Okay. And there were some downsides that the ferritin levels were lower in the adolescent group, probably due to non-compliance. Yeah, that was the hypothesis that the authors presented maybe just due to not taking their multivitamins as regularly, and so just something to be aware of in terms of follow up for these patients. Okay. And the adolescent group did have a higher rate of abdominal operations after their gastric bypass, but the these were usually not related to complications. They were like removing the gallbladder. Yeah, there were some small bowel obstruction operations, but most of the time it was due to a lap chole. Okay. All right, this was a great review. Thank you very much. Yeah, sure thing.