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The lap-band and vertical banded Gastroplasty are essentially the same operation, for all practical purposes. The major difference is that the lap-band is a bit easier to remove. Given the choice, lap-band wins out over the VBG hands down.
The Lap-band and Vertical Banded Gastroplasty (VBG) for children
The advantage of lap-band surgery is that patients have no problem with absorption of any vitamin or mineral. The need for the adolescent to take supplementation is minimal. However, taking vitamins is the least of all the worries. Unfortunately, these operations can be overcome by the foods that all teenagers love—like milkshakes, chocolate, most candy bars, potato chips, or any high carbohydrate food that has little bulk. French fries—and other soft foods, go through this pouch quite easily.
Some weight loss surgeons believe that having a restrictive operation will enforce portion control yet allow the adolescent, who is still developing, to grow normally without loss of “micro nutrients.”
Roux en Y (RNY) gastric bypass weight loss surgery for children
Roux en Y Gastric Bypass has been used on patients as young as 12 years old by a number of surgeons. There is some malabsorption with this surgery, although if a proximal limb is used this is not an issue. The patient will still need to take vitamins and will need to be watched carefully by the pediatrician and the surgeon. The restrictive component of this operation can also be overcome with soft foods; however eating a diet high in carbohydrates may cause dumping with this operation. While there is no relationship between dumping and weight loss, the negative reinforcement might be considered quite cruel if the adolescent can never tolerate carbohydrates again.
The main issue with this surgery is the inability to see the lower stomach, which is completely separated from the upper stomach. This is important because an ulcer can develop in the lower stomach. Usually with an ulcer a stomach doctor, or gastroenterologist, can place an endoscope through the mouth and into the stomach and examine the stomach. After the RNY surgery, the stomach is divided in half, so the only way to reach the stomach is to go through the stoma and go around, but this is very difficult, if not impossible, to do. The other issues with the RNY surgery are that some surgeons do not like their patients to have foods containing fiber, or fruits containing pulp. This can be a problem because fruit juices have a higher glycemic index than do the fruits themselves.
Duodenal Switch gastric bypass weight loss surgery for children
Duodenal Switch surgery has been used with several children who had compulsive eating disorders. DS allows a more normal diet—that is, one that allows fiber, fruit, and vegetables, and this is a plus. This operation also allows patients to have medications such as aspirin, Motrin, or other non-steroidal anti-inflammatory drugs. The down side is that the DS does bypass a fair amount of small bowel. The concern over calcium intake in a patient who is still growing is a real one, as calcium is essential for growing bones. There is also a concern that a number of other “micro nutrients” which we don’t know about yet might not be absorbed—however, this has yet to be the case.
It is essential that the Duodenal Switch surgeon who operates on adolescents have a close working relationship with the family and with the pediatrician. All of the operations work well for adolescents, and the right operation for the adolescent is going to be debated in the literature for a number of years. Taking vitamins, minerals, and careful monitoring of their blood levels is mandatory, as it is with adults. The possibility of needing life-long shots, or intravenous iron, or other supplements is real. A psychological evaluation is also essential and getting the counselor involved in the patient's care is helpful.
After gastric bypass surgery the child's life will never be the same again
As with adults, these operations are life-altering. The child's life will never be the same again. It will probably be much better. Most children adapt well to the changes and look forward to being more like their friends and schoolmates. The children love seeing the weight loss, often feel better, and participate more and more in sports and other physical activities. This should be encouraged and fostered. The risks of surgery in adolescents are similar to that in adults. However, they seem to recover quickly from the operation. It's great to be young. It is fun to see these young people flower and enjoy their bodies.
When I was that age, I was fortunate, we had physical education classes that were intense and I lost a fair bit of weight during those adolescent years. Some schools are not so fortunate and some kids simply will not be able to lose weight as their adult counterparts do, without having surgery.
