Background

More adolescents are requiring bariatric surgery, and pediatric surgical programs are building bariatric capacity in response. Adolescent patients with severe obesity often need complex medical and psychosocial support, necessitating familiarity, experience, and protocols for safe surgical care. This study aims to evaluate the learning curve for a pediatric bariatric program, from initiation with mentorship from our adult program partners, to more independent practice and MBSAQIP accreditation.

Methods

Retrospective review of prospectively collected data from the first 100 laparoscopic sleeve gastrectomy patients at a freestanding academic children's hospital. Demographics, perioperative, and follow-up data were collected to reflect the ASMBS recommended reporting standards.

Results

Results:The first 100 patients were reviewed from 2015-2022. Mean preoperative BMI was 50.2 kg/m2 (37-70.2), mean age 17.4 years. At a median follow-up time of 17 months (range 1-71 months) the average dBMI was 12.1, average percent total weight loss was 21.8% (range: 11.1% gained to 57.2% lost). Average operative time decreased from quartile 1 (127.6min) to quartile 4 (65.3min), as did length of stay (years 1-4: 3.2 days, years 5-8: 2.2 days), and overall postoperative narcotic doses (8.4 to 1.8). Adult bariatric surgery mentors were present for 50 cases overall. One patient experienced postop bleeding requiring transfusion and one suffered a superficial wound infection.

Conclusions

Partnership with an established high-volume bariatric center and accumulation of experience, followed by systematic implementation of quality and safety measures through MBSAQIP, can substantially improve the care provided to adolescent patients during the building of a pediatric bariatric program.