Bariatric surgery

Key points

NHS England guidelines

Criteria (all must be met)

• The adolescent has a post pubertal BMI ≥40kg/m² (BMI SD ≥3.0) or ≥35kg/m² (BMI SD ≥3.5) + significant associated comorbidities that are both predicted to have the potential to progress and are amenable to improvement/ resolution by weight loss

• Obesity should have been present for several years

• Achieved physiological maturity (Tanner Stage 4 or above)

• Had intensive management in an appropriate MDT-led service for > 6 months and < 2 years

• The adolescent is generally fit for anaesthesia and surgery

• Adequate consent

• Motivated patient and family

Pre-operative workup

Psychology + dietician

USS for fatty liver + Gallstones (can have cholecystectomy at operation)

Sleep study

OGD

Surgical options

Gastric banding

Sleeve gastrectomy

Roux en Y gastric bypass

Biliopancreatic diversion with duodenal switch - intentional induction of malabsorption

Page edited by Mrs Charnjit Seehra BSc November 2024

References

Clinical Commissioning Policy: Obesity surgery for children with severe complex obesity Reference: NHS England: 16053/P 2017