الفهرس 
PathophysiologyOnly 14 pages are availabe for public view
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Abstract
Background: Obesity is a growing serious health problem in children and adolescents. The Management plan worldwide is a stepwise approach that involves lifestyle changes and bariatric surgery. Different surgical options are available for obese adolescents. Restrictive operations; Adjustable Gastric Banding (AGB), and Vertical-Banded Gastroplasty (VBG). Mal-absorptive operations; Biliopancreatic Diversion (BPD) with or without Duodenal Switch (DS), and combined; Gastric Bypass (RYGBP). Although all are valid in adults, there has been controversy among the scientific bodies to define the standard surgical treatment, because of the concerns surrounding bariatric surgery in this particular age group.
Methods: This is a prospective study conducted at Ain Shams university hospital in 40 obese adolescents allocated equally into 4 groups and offered randomly AGB, VBG, RYGBP or BPD/DS and followed-up for 1 year, after failure of conservative treatment and legalization has documented. Each patient’s BMI was above the 99th percentile for age and sex. All patients had one or more comorbidities.
Results: The average age was 15.3 (13-18 years), The average BMI
was 55.2 ± 8.4Kg/m2, and Excess Body Weight (EBW) was 84.8 ±
22.6 kg. Each type of surgery has induced significant weight loss. The average EBW loss was 93.1±5.6, 78.5±14.6, 66.9±24.1, and
51.7±23.1 kg for BPD, RYGBP. VBG, and AGB, respectively. BPD was the most powerful in reducing Body weight and resolution of comorbidities , but with higher complications rate.
Conclusions: RYGBP is the surgical treatment of choice for obese adolescents, because it has superior outcomes to VBG and AGB with acceptable complications rate, and comparable weight loss to BPD/DS. BPD should be preserved for patients with Prader-Willi Syndrome.