Lap-Band Surgery for Adolescents NYU Medical Center Program for Surgical Weight Loss George...
-
Upload
isaac-paul -
Category
Documents
-
view
217 -
download
1
Transcript of Lap-Band Surgery for Adolescents NYU Medical Center Program for Surgical Weight Loss George...
Lap-Band Surgery for Adolescents
NYU Medical Center Program for Surgical Weight Loss
George Fielding, MDAssociate Professor of Surgery Evan P. Nadler, MDAssistant Professor of Surgery, Director of Minimally Invasive Pediatric SurgeryChristine Ren, MDAssistant Professor of Surgery
NYU Adolescent Bariatric Experience
Three Phases:Brisbane, Australia (1998-2004) n= 41Off-label experience (2002- 4) n= 41FDA Study (2005) n=17
Brisbane n=41 17.1 YRS ( 12-19)
Y No. Wt (lbs) BMI % EWL0 41 275 431 21 210 32 502 18 200 29 693 16 200 29 704 5 193 29 636 3 171 27 65
Teenagers ? Success
80% had lost at least 50% of their excess body weight at 36 months
80% had a BMI < 30 kg/m2 at 36 months
Visits in 2 yrs: 12.3 (5 - 22)
NYU Bariatric Program
Largest lap- band experience in worldDedicated to long term follow-upMulti-Disciplinary In-house Nutritional TeamIncludes Pediatric SurgeonPsych care at NYU Child Study Centre
Lap- Band in AdolescentsDemographics n= 58
GenderFemale: 46Male: 12
Age13yrs 514-17 yrs 4018-19 yrs 13
RaceCaucasian 50Hispanic 5African American 3
Pre-OP Co-Morbidities
PreOp Co-MorbiditiesDyslipidemia 22 %
Depression 20 %
Type 2 DM/IGT 20 %
LBP 20 %
OA 17 %
Asthma 17 %
HTN 14 %
PCOS 14 %
GERD 9 %
OSA 7 %
Skin Rashes 6 %
N: 58
Pre-Op Weight and BMI
Pre-OP and OP Data
Average Initial Wt
Average Initial BMI
296.31 lbs 47.43
Average OR Time
AverageLOS
35 mins 24 hrs
Lap BandPeri-operative complications
All patients discharged <24 hrsIncreasing use of same-day approachComplicationsMortality 0PE 0Acute re-op 0Acute readmission <30 days 1
(perforated appendicitis)
Follow Up Weight Loss Report
Avg Initial
Wt
AvgInitialBMI
F/UAvg Wt
Avg BMI
Avg %EWL
N
296 47.43 n/a n/a n/a n/a 58
3 months 268 42.76 17.79 39
6 months 252 39.76 34.87 31
9 months 232 36.91 46.61 29
306 48.53 12 months 218 34.44 57.11 13
343 54.67 18 months 248 39.53 49 6
335 54.36 2 Years 239 38.66 50.2 5
337 55.42 3 Years 249 41.08 42.5 4
356 63 4 Years 170 30 82 1
Post-OP 1 Year Nutritional Panel
Reference Range
Fe 57.5 37-170
Folate 10.9 >2.8
VitB12 419.6 239-931
N: 6
14-17 Years Old n=40
Average OR Time 34
Average LOS 24
Gender
Male 8
Female 32
Race
Caucasian 33
Hispanic 4
African American 3
14-17 Years Old
Age
14 years old 3
15 years old 7
16 years old 11
17 years old 19
Trial
FDA Trial 15
Non FDA Trial 25
Wt Loss & Complications
AvgWT
AvgBMI
Avg%EWL N Complication
Initial 292.70 46.93 n/a 40 none
3 months 270.85 42.80 19.48 28
1, Perforated Appendicitis and
1, Gastroenteritis
6 months 245.15 38.93 36.42 21 none
9 months 237.66 37.46 47.13 171, Hiatal Hernia and
1, Band Slip
12 months 224.20 35.38 55.50 11 1, Hiatal Hernia
18 months 240.00 36.13 56.00 3 1 Band Slip
2 years 211.33 37.40 51.00 3 none
3 years 223.00 39.43 42.33 3 none
4 years 170.00 30.00 82.00 1 none
Lap – Band ComplicationsReflux (GERD)
All patients have yearly esophagrams 4 / 58 patients have complained of reflux symptoms,
typically in the evening All 4 then had diagnostic esophagrams Findings: 2 true slips 2 concentric dilatations ( hiatal hernia) Outcome: 2 patients hiatal hernia repair 2 patients repair slipped band All 4 done as day- cases All 4 resolved, off treatment, band re-
adjusted, ongoing weight loss
FDA STUDY:
STUDY TITLE: A prospective, open-label study to evaluate the safety
and efficacy of Lap-Band® Adjustable Gastric Band (LAGB®) Operations in the Treatment of Morbidly Obese Adolescents (Ages 14-17)
STUDY OBJECTIVES: to demonstrate the safety and efficacy of the use of the
LAP-BAND® System in the morbidly obese adolescent population in the United States, and therefore provide these individuals with a significantly less morbid and reversible surgical option for weight loss.
to assess the status of co-morbidities and changes in quality of life from baseline.
FDA Trial (Age 14-17)
Patients enrolled : 22 Patients had surgery : 17
GenderFemale: 13Male: 4
Age14 years old: 415 years old: 416 years old: 517 years old: 4
RaceCaucasian: 10
Hispanic: 5African American: 1Native American: 1
Pre-Op Co-Morbidities
Pre-OP Co-Morbidities
DM or IGT 37%
Back Pain 37%
Dyslipidemia 37%
Depression 31%
OA 25%
Asthma 19%
GERD 19%
Hypertension 19%
Exertional Dyspnea 19%
Stress Incontinence 6%
Lipid Panel
Lipid Panel
Cholesterol
Triglycerides HDL LDL
CholHDLRatio
Pre-OP(N:17) 163 118 37 99 4.68
Post-OP (N:4)
3 months 159 122 41 94 4.08
Nutritional Panel
FeFolat
e VitB12VitD
Hydroxy PTHPhos
phorus Mg
Pre-OP(N:17) 60.13 17.05 494.84 24.56 34.57 4.07 4.40
Post-OP(N:4)
3 months 37.25 11.15 530.50 17.25 31.75 3.45 1.98
Post OP Weight Loss
Initial WT(N:17)
Initial BMI(N:17)
3 monthsF/U Wt(N:4)
3 months F/U BMI
(N:4)
3 Month F/U % EBW
(N:4)
293 47.64 274.33 42.92 17.76