Analyse rétrospective d’une cohorte d’adultes de moins de 25 ans opérés d’une chirurgie bariatrique

Abstract : Introduction :
Obesity reaches more young adults, at an early time and with more severity. Few studies have been interested in the follow-up of medico-psycho-social data in bariatric surgery before the age of 25 years. The main objective was to describe a cohort subjects operated before the age of 25 years, then to identify predictive factors leading to lost to follow-up and/or surgical failure.
Methods :
This retrospective study included subjects whose age was less than 25 years at the time of a first bariatric surgery practiced in our academic hospital between 1997 and 2014. Failure of surgery was defined by an excess weight loss (EWL) < 50 %.
A cohort with a so-called optimal follow-up was built with patients that were still followed at the time when the percentage of lost to follow-up stop to grow. We were unable to reach the whole cohort, finally some of them were actually reassessed, thus defining the reassessed cohort.
Results :
The total cohort contains 328 patients, among whom 86.6 % were women. The average age and BMI at surgery were, respectively, 22 ± 2 years, and of 42,5 ± 4 kg/m2. Co-morbidities were as follows: high blood pressure and sleep apneas, 9.7%; dyslipidemia, 8.2%; Type 2 diabetes, 5.4 %. Only 35.9 % of the subjects has been enrolled pre-operatively in some kind of specific survey (13.4 % of pediatric clinic, 21.7 % of stay in nutritional clinic, 18.4 % of therapeutic education program). Surgery type was mainly gastric bypass (69.2%), then sleeve gastrectomy (20.1%), lap-band (7%), and Mason (3.6%). The percentage of lost to follow-up was respectively at 1, 2, 5 and 10 years of 28 %, 49 %, 65 %, and 67 %. Mortality was 0.3 % (n=1), while global morbidity was 0.6% (n=2). The reassessed cohort contains 50 patients (15.2 %), from which 12 (26 %) were identified as failure. This cohort was statistically no different to the wole cohort.
Only pre-operative follow-up in a pediatric environment was identified as a significant predictor of an optimal follow-up (p<0.006). The only factor of surgical failure was an educational level lower than the high school diploma (p<0.028).
Conclusion :
The number of loss follow-up patients in this study is one of the most worrisome data. Only one third of the patients were enrolled in a pre-surgical specific care; while finally such a pre-operative care appeared to be predictive of an optimal follow-up. The current idea is to strengthen a specific preoperative care in order to improve the follow-up the efficiency of the surgery, and to and prevent complications. Bariatric surgery for teenagers and young adults is particularly at risk of break of follow-up with little known long-term consequences; it must be particularly supervised.
Document type :
Master Thesis
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Alexandre Jehl. Analyse rétrospective d’une cohorte d’adultes de moins de 25 ans opérés d’une chirurgie bariatrique. Médecine humaine et pathologie. 2017. ⟨dumas-01982584⟩

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