SURGERY IN CHILDREN AND ADOLESCENTS
Obesity is already a public health problem that is reducing life expectancy. If this trend continues, the time will come when this condition is the cause of more deaths worldwide. There are also many chronic noncommunicable diseases related to obesity, such as diabetes, hypertension, coronary disease, cerebral vascular disease, dyslipidemias, diseases of the musculoskeletal system, breast, esophagus, colon, endometrial and kidney cancers, among the most frequent ones. Overweight and obesity are recognized as a major challenge in public health in Mexico and the world, due to their magnitude, rapid growth and the negative effect on the health of the population that suffers them. Mexico is not only one of the nations with one of the highest prevalence rates of overweight and obesity, but the increase of these conditions has occurred with greater speed. Obesity has become important in all age groups, in both sexes, in all socioeconomic strata and regions of the country.
Obesity in children is prevailing so much, that one could almost speak of an epidemic. Basically there are 2 main factors that promote overweight which are poor diet and sedentary lifestyle. Obesity in the infant leads to physical and psychological damage.
The most evident but not the most important physical consequence of overweight is the excessive accumulation of fat in the body, triggering the malformation of the body giving a bulky appearance, as well as:
Psychological and educational consequences
Difficulties in relating
Anxiety caused by discrimination
Displeasure with school
His/her major concern is not to make fun of him or her
Known as the chubby child in his/ her classroom
In OBEDI we focus on the strict comprehensive management of children with obesity problems (including pediatrics, pediatric endocrinologist, paidopsychology) and surgical management, since conservative methods allow very limited results. Follow-up studies have shown that between 42 and 77% of adolescents who are obese will remain in this condition in adult life, with a relative risk of 4 to 6.5 times, in addition to that the perspective of life is reduced in more than 20 years. Added to this, if one of the parents is obese, it increases up to 80% the possibility of being an obese adult in the future.
Since life expectancy and mortality in adolescents is affected by the associated diseases, today life expectancy for obese adolescents is bariatric surgery, particularly because it allows in a large percentage not only to reduce their excess weight, but to control chronic degenerative diseases. Recently the Guidelines of the International Group of Pediatric Endoscopic Surgery have been published which establish surgery in these children before the comorbidities irreversibly damage their health. The indications are: BMI> 35 with some associated comorbidity or BMI> 40 with and without comorbidities.
It is clear in these guidelines and in the established in the universal literature that the participant multidisciplinary group must have preparation and experience in the area, that the evaluation system must be very rigid and punctual, that must take into account many factors such as: metabolic, endocrinological, nutritional, cardiological, psychological and orthopedic conditions, support networks, part of skeletal and sexual maturity. In addition to having failed with conservative treatment.
The surgical team must be made up of surgeons with training and experience in bariatric surgery, as well as the group of anesthesiologists who play a very prominent role in these very high surgical risk children.
Surgical techniques are basically divided into three types:
A) RESTRICTIVE: Those that reduce the gastric capacity (adjustable gastric band and gastric sleeve)
B) MALABSORPTIVE: Those that reduce the absorption of nutrients when isolating large segments of small bowel.
C) MIXED: Those that combine the previous ones (Roux-en-Y and laparoscopic gastric bypass)