Clinical Scorecard: Long-Term Results of One-Anastomosis Gastric Bypass in Pediatric and Adolescent Patients with Obesity: Assessing Safety, Efficacy, and Improvement of Obesity-Related Health Issues

At a Glance

Key Highlights

• OAGB is the third most common bariatric procedure worldwide and shows outstanding outcomes with low postoperative complications in adults.
• Limited but growing evidence supports OAGB safety and efficacy in adolescents, with improvements in anthropometric, nutritional, metabolic, and obesity-related conditions.
• This study analyzed 91 adolescents from two centers over 4 years, assessing weight loss, nutritional/metabolic markers, and remission of obesity-related diseases.

Guideline-Based Recommendations

Diagnosis

• Include adolescents with BMI > 40 kg/m2 or BMI > 35 kg/m2 with obesity-related medical problems per American Academy of Pediatrics and IFSO guidelines.
• Diagnose T2DM using 2008 ADA criteria with HbA1c addition; hypertension defined as BP ≥ 140/90 mmHg or antihypertensive use.

Management

• Perform laparoscopic OAGB with a 15–18 cm gastric pouch and 150–180 cm biliopancreatic limb bypass.
• Preoperative multidisciplinary evaluation including history, physical exam, lab tests, and counseling on risks and benefits.
• Postoperative follow-up at years 1, 2, 3, and 4 to monitor anthropometric, nutritional, metabolic, and obesity-related outcomes.

Monitoring & Follow-up

• Assess weight, BMI, excess weight loss percentage, and total weight loss percentage at each follow-up.
• Monitor nutritional markers: hemoglobin, vitamin B12, protein, albumin, calcium, and HbA1c.
• Evaluate remission or improvement of obesity-related conditions: T2DM, hypertension, depression, PCOS, OSA, and GERD.

Risks

• Potential nutritional deficiencies requiring monitoring due to malabsorptive component of OAGB.
• Surgical risks minimized by experienced surgeons and standardized protocols; no closure of Peterson defect and no anti-reflux stitches used.
• Limited long-term data in adolescents necessitates careful patient selection and follow-up.

Patient & Prescribing Data

91 adolescents aged 11–21 years with severe obesity undergoing OAGB at two centers in Egypt and Lebanon.

OAGB resulted in significant weight loss and improvements in metabolic and obesity-related conditions over up to 4 years, with low complication rates.

Clinical Best Practices

• Select adolescent patients based on established BMI criteria and presence of obesity-related comorbidities.
• Conduct thorough preoperative evaluation and multidisciplinary counseling involving surgeons and dieticians.
• Use standardized laparoscopic OAGB technique with consistent limb lengths and pouch size.
• Implement structured postoperative follow-up assessing anthropometric, nutritional, metabolic, and clinical outcomes at multiple time points.
• Monitor for nutritional deficiencies and manage accordingly to support adolescent growth and development.
• Document remission criteria for obesity-related conditions using standardized definitions (e.g., ADA criteria for T2DM).

References

• American Academy of Pediatrics Guidelines
• International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Guidelines
• American Diabetes Association Standards of Medical Care in Diabetes—2008