Abstract
Background
Obesity is a leading cause of mortality and morbidity in Prader-Willi syndrome (PWS).
Objectives
To study weight loss and growth after laparoscopic sleeve gastrectomy (LSG) in pediatric
patients with PWS compared with those without the syndrome.
Setting
Academic center with a standardized care pathway for pediatric bariatric surgery as
a part of a prospective clinical outcome study on children and adolescents undergoing
weight loss surgery.
Methods
Clinical data of all PWS patients who underwent LSG were abstracted from our prospective
database, which included all pediatric patients who underwent bariatric surgery. These
data were then compared with a 1:3 non-PWS group matched for age, gender, and body
mass index (BMI). Data for up to 5 years follow-up were analyzed.
Results
The 24 PWS patients (mean age 10.7; 6<8 yr old, range 4.9–18) had a preoperative BMI
of 46.2±12.2 kg/m2. All PWS patients had obstructive sleep apnea (OSA), 62% had dyslipidemia, 43% had
hypertension, and 29% had diabetes mellitus. BMI change at the first, second, third,
fourth, and fifth annual visits was –14.7 (n = 22 patients), –15.0 (n = 18), 12.2
(n = 13), –12.7 (n = 11), and –10.7 (n = 7), respectively, in the PWS group, whereas
the non-PWS group had a BMI change of –15.9 (n = 67), –18.0 (n = 50), –18.4 (n = 47),
–18.9 (n = 26), and –19.0 (n = 20), respectively. No significant difference was observed
in postoperative BMI change (P = .2–.7) or growth (postoperative height z-score P value at each annual visit = .2–.8); 95% of co-morbidities in both groups were in
remission or improved, with no significant difference in the rate of co-morbidity
resolution after surgery (P = .73). One PWS patient was readmitted 5 years after surgery with recurrence of OSA
and heart failure. No other readmissions occurred, and there were no reoperations,
postoperative leaks, or other complications. No mortality or major morbidity was observed
during the 5 years of follow-up. Among the PWS patients who reached their follow-up
visit time points the total follow-up rate was 94.1%, whereas in the non-PWS group
it was 97%. All patients who missed a follow-up visit were subsequently seen in future
follow-ups, and no patient was lost to follow-up in either group.
Conclusions
PWS children and adolescents underwent effective weight loss and resolution of co-morbidities
after LSG, without mortality, significant morbidity, or slowing of growth. LSG should
be offered to obese PWS patients with heightened mortality particularly because no
other effective alternative therapy is available.
Keywords
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Article info
Publication history
Published online: July 22, 2015
Accepted:
July 21,
2015
Received:
June 5,
2015
Identification
Copyright
© 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
