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SPRINGFIELD – Weight loss surgery, recently introduced at Baystate Children’s Hospital, could mark the end of chronic adolescent obesity-related health problems.

Dr. Michael Tirabas began a laparoscopic gastrectomy in patients aged 15 to 20 years. It can help eliminate obesity when behavioral and lifestyle changes do not provide the necessary weight loss of 100 pounds or more.

It involves the permanent removal of most of the stomach, which has been performed on adolescents in other hospital systems, but only in recent months by Tirabassi as part of the Baby Weight Management Program at Baystate Children’s Hospital. It occurs when obese adolescents are increasingly being treated for a variety of medical conditions, from type 2 diabetes to sleep apnea to high blood pressure.

Previously, young patients in a weight management program led by Dr. Rushika Conro, who wanted bariatric surgery, waited until they were 18 years old. They could switch to Baystate Health Adult Bariatric Surgery or choose elsewhere as there was no such option before. For people under 18 in West Massachusetts.

Conroe said estimates show that about 20% of the pediatric population is obese, with 4 to 6% considered obese. He said adolescents with severe obesity should lose more than: 100, who benefit from bariatric surgery to help with sustainable weight loss and eliminate the risk of developing long-term chronic illness.

Dr. Rushika Conroy, Director of the Child Weight Management Program at Baystate Children’s Hospital, Springfield, see here in 2021. On August 17. (Baytstate Health photo)

Tirabassi, a veteran pediatric surgeon, teamed up with Dr. John von Romanelli, a Baystate adult bariatric surgeon, to prepare for pediatric weight loss surgery.

“The problem with adolescent and adult weight loss is that people can succeed in short-term weight loss quite often,” Tirabasi said.

He added. “They are on a diet to lose weight. However, the success rate of staying on a diet forever is very low, և weight is gained back. The real role of bariatric surgery in children and adults is not only to lose weight, but also to be successful in the case of long-term weight loss. Weight loss will be followed by fatigue and constant tiredness. That’s the success we’re looking for. “

“Surgery to lose weight” takes 45 minutes to two hours, depending on the patient; they are usually in the hospital for two nights after surgery, “Tirabasi said.

He stressed that the surgery currently offered at Baystate Children’s Hospital is “a small part of a comprehensive program for adolescent obesity” and that “none of the adolescents undergo light surgery”.

“Obesity is a program that we have had for a long time, and surgery has recently added to that,” Tirabasi said. “Patients usually plan to meet with a pediatric endocrinologist, nutritionist, psychotherapist for six months to a few years and work on their weight loss goals before they are ready for surgery.”

The mother of one patient, who was 16 years old at the time of the operation eight months ago, said her daughter had lost 50 of the required 80 pounds since then because her “blood pressure had improved a lot”.

“We’ve been struggling with her weight since birth,” he said. “She tried Mighty at Baystate Children’s when she was just eight or nine years old. She could not lose weight then և we tried other approaches to losing weight. He just did not lose weight. “

The woman, who asked for confidentiality about her daughter’s fight against obesity, called the operation “a last resort”.

“This is the last resort for a parent or child going through this struggle,” he said. “No one should jump into it. This should be. “We have not achieved any other results in terms of weight loss.”

He added that he was “as worried as any mother when your baby was stabbed”, but that his daughter was “really well behaved” and continued to adjust to the dietary changes caused by the surgery.

“It’s not like you have surgery, all the weight goes out right away,” says the mother who underwent gastric bypass surgery 10 years ago. “It’s not like that, he learns it, that it’s a lot more work than expected.”

His daughter, who was an honorary full-time student, agreed, saying some days were “hard”. Some of the foods he likes are now spoiling his stomach, and the emotional transition to a new diet can also cause stomach pain. However, he said that he is slowly adjusting, appreciating Tirabasi for his “kindness” as a medical professional who understands and cures his illness.

“Yes, in general it was worth it,” he said when asked about bariatric surgery.

The onset of the coronavirus epidemic 19 months ago delayed the introduction of laparoscopic surgery into the pediatric program, but Tirabasi said he had performed a low-risk, minimally invasive procedure for about half a dozen patients to date.

He sees his patients “a lot” before or after surgery.

“Two or three times after the operation, different times for it in the cleansing process,” Tirabasi said. :

Tirabasi said that the decision to offer surgeries revises “the data that confirms the patterns of their use.”

“The American Society for Metabolic and Bariatric Surgery has published guidelines for the use of bariatric surgery in both adults and adolescents,” Tirabas said. “They stipulate that the competent adolescent population be 13 years of age or older. “In our minds here at Bastet, we do not really want to operate on people under the age of 15-16 unless their surgery is very special.”

He said patients “really need to be involved in the process to succeed.”

“Every child is different,” Tirabasi said. “But when I meet teenagers, it seems like they’re around 16 when they really start to have that emotional maturity to get involved in the process, to be successful.”

Tirabassi said that surgery, laparoscopic section of the stomach or gastrectomy “removes about 75-80% of the stomach; it is a permanent, irreversible change in the body.”

The reduction causes the individual to feel fuller rather than the less secreted hormone is released when the stomach is empty, which enters the brain to stimulate hunger.

“Patients should go on a full liquid diet for a few weeks before surgery, a liquid diet should be continued until two weeks after surgery, and then they should start some kind of baby food,” Tirabasi said.

“It helps them adjust to the new horse in their stomach,” Tirabas said. “Usually one to two months after surgery is when they finally return to normal food. “But they need to eat smaller meals more often. They choose their food really well.”

“It requires quite a dramatic change in lifestyle,” he added.

Tirabasi said that “most of the patients seen during the consultation have about 100 extra pounds that they need to lose in order to achieve an ideal body weight.”

“Adolescents seem to be a little sicker and have more complications than obesity,” Tirabasi said. “They are a little more likely to have diabetes, joint pain and walking problems.”

He attributed this to the “nature of the referral process”.

“There is this way of thinking, not to think of adolescents as a right to bariatric surgery,” Tirabasi said. “It is only adolescents who are really in a lot of trouble, their caregivers are starting to think about reaching out, but in fact there is the latest evidence in the literature that adolescents not only do really well with bariatric surgery, but also respond better metabolically. than the adult population. “

For the first two years after the removal of gastric tuberculosis, Tirabas told patients that they could lose about half of their excess weight.

“This is a really big difference in how they treat their bodies,” he said. “It is easier for them to participate in the activity. The biggest thing after bariatric surgery is that the success rate of not losing that weight is high.”

Tirabasi said that a number of factors, including the genetic component, can cause childhood obesity, endangering the young man’s short life without surgery.

“An obese teenager with the disease becomes obese and disabled at the age of 20-30,” said Tirabasi. “Breaking that cycle sometimes requires some dramatic, and sometimes bariatric surgery, the right fit to be dramatic to break that cycle.”

He added.

“These teens have a potentially long life, their lives can be very different after surgery,” Tirabas said. “They lose so much weight that they feel healthy and train again. There is not much opportunity to make such a drastic change in someone’s life, but this is one of them. “

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