Bariatric surgery for extreme adolescent obesity: indications, outcomes, and physiologic effects on the gut-brain axis.
Bariatric surgery for extreme adolescent obesity: indications, outcomes, and physiologic effects on the gut-brain axis.
复制标题
DOI：
10.1016/j.pathophys.2008.04.005
复制
发表时间：
2008-08-01
期刊：
影响因子：
--
通讯作者：
Xanthakos, Stavra A
中科院分区：
文献类型：
--
作者：
Xanthakos, Stavra A
目的：这篇综述将总结目前的适应症，局限性和结果的减肥手术在青少年，以及提供一个概述的生理效应的减肥手术对肠道激素参与调节食欲，饱腹感和维持weight.RESULTS：极度肥胖（BMI≥99百分位）现在影响4%的儿童和青少年在美国。传统的饮食和行为体重管理方法对极度肥胖的儿童和青少年没有明显的疗效，与减肥手术相比，减肥手术对极度肥胖的儿童和青少年产生了显著和可持续的体重减轻，并改善了合并症。Roux-en-Y胃旁路术（RYGB）和腹腔镜可调节胃束带术（LAGB）是青少年最常见的减肥手术，但垂直袖状胃切除术可能是一个有前途的新选择，为选定的极度肥胖的青少年。平均体重减轻37-40%是在青少年后，RYGB，LAGB显示出类似的结果，虽然达到在一个较慢的rate.CONCLUSION：肠激素参与肠-脑轴，调节食欲和能量消耗的改变可能发挥作用，在两个reproductive和减肥效果的某些减肥外科手术。特别是，RYGB诱导空腹和餐后肽酪氨酸-酪氨酸的升高，这可能有助于比LAGB更快和更大程度的体重减轻。然而，减肥手术的局限性包括术后发病率和死亡率的可能性，以及小部分患者体重可能反弹。
OBJECTIVE: This review will summarize current indications, limitations and outcomes of bariatric surgery in adolescents, as well as provide an overview of the physiologic effects of bariatric surgery on enteric hormones involved in regulating appetite, satiation and maintenance of weight.RESULTS: Extreme obesity (BMI≥99 percentile) now affects 4% of children and adolescents in the United States. Traditional dietary and behavioral weight management methods have no demonstrated efficacy for extremely obese children and adolescents, in contrast with bariatric surgery which has produced significant and sustainable weight loss and associated improvements in comorbid diseases for the extremely obese. Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are the most commonly performed bariatric surgical procedures in adolescents, but vertical sleeve gastrectomy may be a promising new option for selected extremely obese adolescents. A mean weight loss of 37-40% is achieved in adolescents after RYGB, with LAGB showing similar results, albeit attained at a slower rate.CONCLUSION: Alterations in the enteric hormones involved in the gut-brain axis that regulates appetite and energy expenditure may play a role in both the anorexigenic and weight-reducing effects of certain bariatric surgical procedures. In particular, RYGB induces a rise in both fasting and post-prandial peptide tyrosine-tyrosine which could contribute to the more rapid and greater degree of weight loss than is seen with LAGB. Limitations of bariatric surgery however include the potential for post-operative morbidity and mortality, as well as possible weight regain in a small proportion of patients.