Welcome

Welcome to the Center for Adolescent Bariatric Surgery at Morgan Stanley Children's Hospital. Our Center offers a comprehensive, multidisciplinary weight management program that includes:

• health and metabolic screening
• nutritional guidance, dietary management, and education
• individualized exercise programs
• laparoscopic adjustable gastric banding
• ongoing follow-up

Our concerned and empathetic staff is dedicated to helping adolescents who are obese lose weight when conventional methods have been unsuccessful. Our surgical team has extensive experience in laparoscopic bariatric surgery and long-term management of patients in a supportive and caring environment.

The Challenge of Childhood Obesity

The prevalence of childhood obesity has risen dramatically in the past several decades.

Children who are obese are at risk for developing lifelong physical and emotional problems. These include Type 2 diabetes, heart disease, high blood pressure, trouble breathing, difficulty sleeping, and degenerative joint disorders. Teenagers who have weight problems tend to have lower self-esteem and can develop depression, anxiety and other psychological issues. Studies also show that the majority of children and adolescents who are obese remain obese as adults.

The Causes of Obesity

The causes of obesity-which include genetic, biological, behavioral and cultural factors-can result from:

• poor eating habits
• lack of exercise
• family history of obesity
• medical illnesses and/or medications
• stressful life events
• family and peer problems
• low self-esteem, depression or other emotional problems

How We Can Help

The Center for Adolescent Bariatric Surgery focuses on the total needs of the adolescent obesity surgery patient. Our dedicated team of experts in pediatric gastroenterology, endocrinology, nutrition, exercise physiology and physical therapy, psychiatry, surgery, anesthesiology, and other specialties offer both medical and surgical options for teenagers who suffer from severe obesity. Patients are followed for at least six months to see how they do on a non-surgical weight management program. If they can lose more than 20 percent of their excess weight in a six-month period on medical therapy then surgery is not indicated.

Laparoscopic Adjustable Gastric Banding

Teenagers between the ages of 14 and 18 who have been obese for more than five years and who have not been able to lose 20 percent of their weight through diet and exercise alone in six months time under our care may be candidates for laparoscopic adjustable gastric banding-a valuable treatment option for achieving a healthy weight.

Outside the United States, laparoscopic adjustable gastric banding is the most common surgical procedure used to treat obesity. Our Center is the first children's hospital-based program in the United States to provide laparoscopic adjustable gastric banding. Currently, our program is one of only three in the nation approved by the Food and Drug Administration to perform the procedure.

In this surgical procedure, we use Inamed Health's BioEntericsR LAP-BANDª System-a minimally invasive, safe weight-loss approach that is the only adjustable and reversible surgical weight-loss option available in the United States.

The procedure helps achieve sustained weight loss by placing an adjustable band around the upper part of the stomach to reduce its capacity. This creates a new small stomach pouch and leaves the larger part of the stomach below the band. The food storage area in the stomach is reduced since the pouch above the band can hold only a small amount of food. The band is connected by tubing to an access port that is placed beneath the abdominal skin during surgery. As the patient loses weight, the surgeon can adjust the band through this port.

(top left) The BioEnterics¨ LAP-BAND¨ System from Inamed Health is a minimally invasive surgical solution that uses an adjustable gastric band for long-term weight loss. (top right) The LAP-BAND System is a silicone elastomer ring designed to be placed around the upper part of the stomach and filled with saline on the inner surface. This creates a new small stomach pouch and leaves the larger part of the stomach below the band so the food storage area in the stomach is reduced, and the pouch above the band can hold only a small amount of food.

While weight loss occurs more gradually than with gastric bypass, weight loss at three years after band placement is approximately the same. Banding offers the following advantages:

• Gastric banding mortality rates are less than 1/10 those of gastric bypass
• Gastric banding is adjustable and reversible and does not reroute the patients' digestive anatomy
• Patients who undergo gastric banding do not experience malabsorption and therefore may not require nutritional supplementation

Gastric banding surgery takes approximately one hour under general anesthesia. There is no cutting or stapling of the stomach or bypassing the intestines. Patients are generally discharged the next day, with the first follow-up visit within two weeks. Because the LAP-BANDR System is placed laparoscopically, there is less pain following the procedure and a shorter hospital stay and recovery period. And, if for any reason the band needs to be removed, the stomach generally returns to its original form.

Our goal is to help adolescents who meet the criteria lose at least 50 percent of their excess weight with banding. Patients are expected to lose between a pound and a pound and a half a week. But if he or she is losing weight much more quickly, then the band may be adjusted to slow that rate. On the other hand, if a patient is not losing at this rate, the band can be tightened.

Since weight loss with the procedure is gradual, we follow patients with regularly scheduled visits until they reach adulthood. At that time, patients transition to the Center for Obesity Surgery, the adult bariatric surgery program at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Candidates for Laparoscopic Adjustable Gastric Banding

All candidates for gastric banding are evaluated by a physician, a pediatric nurse practitioner, and a nutritionist upon enrollment into our program. Candidates for surgical intervention undergo careful screening to identify those patients who are most likely to lose weight successfully with gastric banding and to ensure that they can handle the emotional rigors involved in a dramatic change in lifestyle.

Criteria include:

• Body Mass Index (BMI) of greater than or equal to 40 percent or greater than the 95th weight-for-height percentile, or
• BMI greater than or equal to 35 percent with associated comorbidities (e.g., Type 2 diabetes, hyperlipidemia, hypertension, weight-related orthopedic problems, obesity-related dermatitis, or psychosocial problems)
• A documented supervised weight loss program for a minimum of six months
• Psychological assessment and clearance to participate in the program
• Willingness to pursue a long-term program of monitored weight management

The Center's program has been approved by the Food and Drug Administration (FDA) to use the device in adolescents less than 18 years old. Adolescents 18 years and older do not require FDA approval, and are also eligible for care in our program. If a candidate is less than 18 years old, he or she must be willing to enroll in a study protocol approved by the FDA to evaluate the safety and efficacy of laparoscopic gastric banding in adolescents.

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