Pediatric Bariatric Surgery
Nov 25, 2014 02:48PM ● Published by MED Magazine
During the inaugural procedure, Robert Cusick, M.D., Children’s Specialty Physicians, pediatric surgeon at Children’s Hospital & Medical Center and associate professor of Pediatric General Surgery at UNMC College of Medicine, and Daniel Cronk, M.D., a bariatric surgeon with Methodist Physicians Clinic, removed roughly 60 percent of the 15-year-old’s stomach. The laparoscopic procedure leaves the stomach in the shape of a sleeve or tube and decreases food consumption by triggering an earlier satiety.
“Gastric sleeve resection has become much more common in the last five years and has really shown good long-term outcomes. It’s a less morbid and, we believe, safer procedure,” Dr. Cusick explained.
Nevertheless, bariatric surgery is not a first line response to treating adolescent obesity – it is a last resort. The process always begins in Children’s Weight Management program, called HEROES (Healthy Eating with Resources, Options and Everyday Strategies), the only high-intensity childhood obesity program in the Omaha area.
Cristina Fernandez, M.D., is the medical director of the HEROES Clinic. The program combines medical management; required nutrition, behavior and fitness classes; behavioral health therapy and consultations with medical specialists. Children must undergo an evaluation by the HEROES team to determine if they qualify.
There is agreement among the HEROES team and Children’s surgical staff that all other avenues should be exhausted prior to considering bariatric surgery. Even then, parameters are in place: the adolescent patient must have a BMI > 35 with severe co-morbidities such as sleep apnea, pulmonary hypertension or type II diabetes; a BMI > 40 with more mild co-morbidities; or a BMI > 50 with or without co-morbidities. The adolescent needs to have reached 95 percent of their adult height confirmed by growth charts, tanner staging and/or bone age.
“We also highly consider the patient’s mental state, family support, and willingness to achieve a healthier lifestyle through surgery,” said nurse practitioner Rachel Anthony, N.P.
As of now, gastric sleeve resection is the only bariatric procedure performed at Children’s.
Laparoscopic banding is not FDA approved for children, and a laparoscopic bypass is “a complicated operation with potentially significant complications,” Dr. Cusick said. “We feel the sleeve is the appropriate choice for adolescents, a great first step, with better life habits making the difference from there.”
Prior to surgery, the patient undergoes a minimum of six months of medically managed weight loss supervised by the HEROES team, exercise and nutrition classes, and clinic follow-up to manage any co-morbidities.
The HEROES team plays a vital role in the adolescent’s care post-surgery as well, meeting weekly for the first month to track progress and then every 8-12 weeks during the two-year post-operative care period.
“Follow-up is key. We look at this as an ongoing relationship,” Dr. Cusick said. “The operation by itself will fail. It has to be within the context of a multidisciplinary clinic to make a significant life change.”
Family support is also critical.
“This is why we pride ourselves on being a family-focused program. We know that it takes a healthy family to attain a healthy child,” Anthony said.
Children’s inaugural – and, so far, only – gastric sleeve resection patient has already lost 50 pounds.
“At her last clinic visit, she was all smiles. She is doing and feeling great,” Anthony shared. “Her blood pressure normalized and her lab work was spot on, all good signs that her health is improving. For her, surgery was just the right tool she needed on her path to success.”