Weight Loss Surgery Offers New Hope to Children and Adolescents with Prader-Willi Syndrome

Laparoscopic sleeve gastrectomy is a viable and safe solution for obese pediatric pws patients, reports new study in Surgery for Obesity and Related Diseases

New York, NY, September 28, 2015

Obesity is a leading cause of complications and death in children suffering from Prader-Willi syndrome (PWS), yet there are few effective treatment options for these patients. In a new study published in Surgery for Obesity and Related Disease researchers found that bariatric surgery, specifically laparoscopic sleeve gastrectomy (LSG), resulted in substantial weight loss with no apparent adverse effect on growth in a small group of severely overweight patients with PWS. While bariatric surgery is considered controversial for PWS, the research team is encouraged by their positive results.

PWS is a rare genetic condition that causes a wide range of problems including a constant desire to consume food, which is driven by a permanent feeling of hunger. This can easily lead to dangerous weight gain, and in fact, in PWS obesity is a leading cause of death and related problems such as obstructive sleep apnea, dyslipidemia (abnormally high cholesterol or fats in the blood), hypertension, and diabetes mellitus.

“Questions are raised regarding the safety of bariatric surgery in PWS patients, the degree and sustainability of weight loss and resolution of related health problems, long term results, as well as the effect on growth and skeletal maturity. These concerns stem from the fact that the pathophysiology of obesity in those patients is unique and differs from what is observed in the general population,” explained lead investigator Aayed R. Alqahtani, MD, RCSCS, FACS, of the Department of Surgery at King Saud University College of Medicine, Riyadh, Saudi Arabia.

The study was carried out at King Saud University College of Medicine, which is an academic center with a standardized care pathway for pediatric bariatric surgery. Dr. Alqahtani and co-investigators examined weight loss and growth after LSG in 24 children and adolescents with PWS aged between five and 18 years old and compared the results with patients without the syndrome, who were matched for age, gender, and body mass index (BMI).

“Our study indicates that bariatric surgery should be recommended for pediatric PWS patients; our results are unmatched by any other treatment. All of our patients experienced significant weight loss following LSG. There were no deaths or major complications, no significant morbidity, and no slowing of growth,” reported Dr. Alqahtani. “Most of the weight loss occurred within the first two years after surgery and patients successfully reduced food intake and felt satiated by smaller amounts of food due to reduced stomach capacity.” Data for up to five years follow-up were analyzed, during which time few complications occurred.

The PWS patients had a mean BMI of 46.2 (± 12.2) before surgery. All PWS patients had obstructive sleep apnea, 62% had dyslipidemia, 43% had hypertension, and 29% had diabetes mellitus. The change in BMI at the first, second, third, fourth and fifth annual visits was -14.7 (22 patients), -15.0 (18 patients), -12.2 (13 patients), -12.7 (11 patients), and -10.7 (7 patients), in the PWS group; while the non-PWS group had a BMI change of -15.9 (67 patients), -18.0 (50 patients), -18.4 (47 patients), -18.9 (26 patients), and -19.0 (20 patients), respectively.

Others may have a somewhat different take on the interpretation of these results. “Although the use of surgery in pre-adolescents with special needs is uncharted territory, the results are of interest, particularly since there has been very limited experience with modern bariatric procedures in this patient population,” commented Dr. Thomas Inge, professor of surgery and pediatrics from Cincinnati Children’s Hospital Medical Center. “While it is clearly not possible to make treatment recommendations for use of surgery in this complex population without further research to examine the physiologic impact, these initial findings should at least prompt a new conversation about prospective and more comprehensive studies to examine safety and efficacy of modern weight loss procedures and newer medications in patients with PWS.”

---

Notes for Editors
“Laparoscopic Sleeve Gastrectomy in Children and Adolescents with Prader-Willi Syndrome: A Matched Control Study,” by Aayed R. Alqahtani, MD, RCSCS, FACS, Mohamed O. Elahmedi, MBBS, Awadh R. Al Qahtani, MD, MSc, FRCSC, Jaehoon Lee, PhD, and Merlin G. Butler, MD PhD, FFACMG (DOI: http://dx.doi.org/10.1016/j.soard.2015.07.014). It appears online in Surgery for Obesity and Related Diseases, in advance of its issue,published by Elsevier.

Full text of this article is available to credentialed journalists upon request. Contact Elizabeth Perill at +1 212 633 3833 or hmsmedia@elsevier.com to obtain copies. Journalists wishing to interview the authors may contact Aayed R. Alqahtani, MD, RCSCS, FACS at +966507475363 or qahtani@yahoo.com. Dr. Inge may be reached for comment at Thomas.inge@cchmc.org.

About Surgery for Obesity and Related Diseases
Surgery for Obesity and Related Diseases (SOARD),
the Official Journal of the American Society for Metabolic and Bariatric Surgery (http://asmbs.org) is an international journal devoted to the publication of peer-reviewed articles of the highest quality with objective data regarding techniques for the treatment of severe obesity. Articles document the effects of surgically induced weight loss on obesity physiological, psychiatric, and social co-morbidities. SOARD is ranked 13th of 198 journals in the Surgery category in the 2014 Journal Citation Reports®, published by Thomson Reuters, and has an Impact Factor of 4.066.

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

Media contact
Elizabeth Perill
Executive Publisher, Elsevier
+1 212 633 3833
hmsmedia@elsevier.com