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I commend Dr Shield and colleagues for their 9 year-old
multidisciplinary obesity service for children and adolescents and I am
delighted that a bariatric surgeon is now part of the team. Longterm
results are still awaited to prove the benefits of this approach to weight
loss in teenagers, but short-term evidence is very promising as the
authors have pointed out.
I would like to describe...
I would like to describe my experience with bariatric surgery as a
'pure' paediatric surgeon in the hope that more of my colleagues will
become involved with their local childhood/adolescent obesity service. I
began to attend monthly 'adult' bariatric multidisciplinary team meetings
(MDTs) in my 5th year of SpR training in paediatric surgery in London.
This gave me an insight into the evaluation and selection process that
obese adults undergo prior to any procedure.
Since I finished my training in paediatric surgery in April last, and
with the support of my senior colleagues, I have combined locum
consultancy in paediatric surgery with a bariatric clinical fellow post
here in London. I organise the 'adult' MDTs, assess new patients
considering bariatric surgery, and follow up patients post-operatively in
clinic. I have assisted with 11 bariatric procedures to date (one in a 19
year-old) and there are 2 cases per week for the forthcoming months.
I have helped to establish a group of interested professionals at St.
George's to provide an adolescent obesity service much like the authors
describe. I have visited the adolescent bariatric units at Cincinnati
Children's hospital, New York University Medical Center and Lucille
Packard Children's Hospital in Stanford. Each centre was very welcoming
Everybody agrees that bariatric surgery should be offered to
teenagers within an MDT setting. Close co-operation with an 'adult'
service is essential for access to expertise and equipment. I urge
paediatric surgeons to be part of this process (particularly
Laparoscopists) and to attend their unit's obesity service meetings. If a
service does not exist, create one!
Niall Jones MD FRCSI(Paed)
Bariatric Clinical Fellow and Honorary Consultant Paediatric Surgeon