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Packard Children's Hospital performs new weight-loss surgery on teenager

Lucile Packard Children?s Hospital

Surgeons Craig Albanese, John Morton and Sanjeev Dutta check monitors while performing the first gastric band operation at a children’s hospital in California.

BY KRISTA CONGER

Squeezing into a smaller size is more than just a cosmetic dream for obese children. For many, drastic downsizing is the only way to escape major medical complications related to their excess pounds. A reversible, minimally invasive procedure in which the stomach is cinched up like a recalcitrant waistline gives these teens an alternative to gastric bypass. On May 18, Lucile Packard Children's Hospital became the first California children's hospital to perform the procedure, called gastric band surgery.

"These procedures are for teens suffering from severe, often life-threatening complications of obesity," said Craig Albanese, MD, chief of pediatric surgery at Packard Children's and a pioneer in minimal-access surgical techniques. "One hundred percent of these teens have very serious medical problems. This isn't just 'I want the surgery so I can look better.'"

Albanese, together with John Morton, MD, director of bariatric surgery at Stanford Hospital & Clinics, worked together to perform the procedure on the 400-pound-plus patient, who wishes to remain anonymous. Albanese is also a professor of surgery at the medical school, and Morton is an assistant professor of surgery.

Although the gastric band surgery, or lap band, is widely used in Europe and Australia, the gastric bypass operation, which involves cutting or stapling the stomach to permanently decrease its size, is more common in the United States. In 2004, Packard became the first children's hospital in the state to offer gastric bypass surgery to obese adolescents, and 10 teens have since undergone the procedure.

Diabetes, high blood pressure and joint problems are only a few of the problems that can afflict severely overweight children. Others include liver problems, lung and breathing problems, and increasing pressure in the brain that can cause vision impairment or blindness. These complications don't only threaten the child's health and well being, they can also make the surgery itself very challenging.

"Often this type of very heavy patient is not offered a laparoscopic weight-loss procedure," said Morton. "However, we were able to draw on our extensive experience in this area to successfully place the lap band with minimal-access techniques, even though the patient's liver was extremely enlarged."

Morton has performed about 100 lap band surgeries on adults since Stanford Hospital & Clinics began offering the procedure. All told, more than 1,000 weight loss surgeries have been performed at Stanford.

During the surgery, four to five small incisions are made in the patient's abdomen and a band about the size of a shower curtain ring is cinched around the upper portion of the stomach to create a small pouch below the esophagus. The constriction slows the passage of food from the pouch into the remainder of the stomach and causes a sensation of fullness after only a few bites.

Unlike the gastric bypass operation, the lap band is removable and adjustable. The interior diameter of the band can be changed by adding or removing a liquid through a port under the skin of the patient's abdomen. Because lap band patients can eat small quantities of any type of food—in contrast to bypass patients who often have problems digesting sweets—and because they can still feel hungry when full, they experience more gradual weight loss than do bypass patients.

The May 18 procedure took about an hour, and the patient was planning to return home over the weekend. Morton and Albanese anticipate that the lap band procedure will become more common in adolescents if and when the device receives FDA approval for pediatric use. Without such approval, many health insurance companies are reluctant to cover the costs of the lap band surgery in teens.

The band procedure increases medical providers' ability to tailor treatments to meet the specific needs of each child, said Albanese. "The lap band might not be for everyone; the bypass might not be for everyone, and even surgery might not be the best answer for some," he said. "But we're committed to offering patient-specific therapy to help kids fight obesity and this is another weapon in our arsenal. These kids are sunk if we don't help them."