Pediatric Surgery Obesity Management

Childhood obesity has become an epidemic in the United States, posing a great health challenge to our society. Obese children and adolescents are at high risk of developing type 2 diabetes, cardiovascular disease, high blood pressure, high cholesterol, and other serious health problems. These children are also more likely to develop morbid obesity in adulthood. At UCSF, we take a comprehensive team approach to treating children and adolescents with obesity.

Weight Assessment and Non-Surgical Treatment

If your child is overweight or obese, the first step is to ask your pediatrician for a referral to the UCSF WATCH (Weight Assessment for Teen and Child Health) clinic. The clinic brings together doctors, nutritionists, exercise physiologists, and psychologists with expertise in diagnosing and treating childhood obesity. These experts will evaluate your child and develop a plan to manage your child's weight through nutrition education and behavior modification. Please visit the WATCH clinic website for more information.

Every effort is made to achieve weight loss non-surgically, but for a small group of children, medical, behavioral, and nutritional approaches to weight loss may not be enough. In these cases, the WATCH medical team may refer you and your child to see a pediatric surgeon to discuss surgical options. We will work together with you and the WATCH clinic team to tailor treatment to your child's individual needs. Due to the considerable lifestyle changes that surgery will bring about, your family and child must continue to commit to a strict program of healthy eating and exercise before he or she can be a candidate for surgery.

Surgical Treatment of Obesity

For children who meet the criteria for obesity surgery, the goal of surgery is to be a tool to assist in improving your child's health. It is important to understand that obesity surgery is not cosmetic surgery, nor is it an "easy way out." Surgery is a tool-not a cure-for sustained and effective long-term weight loss in children for whom other weight management strategies have failed.

We currently offer only one type of obesity surgery for children: laparoscopic gastric banding. Our team does not perform gastric bypass surgery for children due to the high risk of serious complications, the irreversible nature of the procedure, and the unknown long term consequences.

Laparoscopic Banding

Laparoscopic gastric banding (aka lap-band) is a minimally invasive surgical procedure. While your child is under anesthesia, the surgeon will use a miniature camera and small surgical instruments inserted through 3-5 tiny holes to place an adjustable silicone band around the stomach. A port, which allows for tightening of the band, will also be placed underneath the skin.

The band will divide the stomach into a small upper pouch and a larger lower pouch. The small size of the upper pouch limits the amount of food your child can eat by making him or her feel full much sooner. The surgeon can adjust the tightness of the band by adding or removing fluid through the port, which decreases or increases the size of the upper pouch. The frequency of band adjustments will depend on the child's weight loss, appetite, activity level, and the overall goals of the child, family, and surgeon.

When will my child be able to go home?

Your child will typically go home within 23 hours after the surgery.

What do I need to do after the operation?

For the first 2-3 weeks after surgery, your child will be on a diet of clear liquids. He or she will then begin a soft diet, and will move on to small amounts of solid food as directed by the surgeon. Food must be chewed thoroughly, liquids should be consumed separately from solids, and each meal should consist of no more than 4-6 ounces of food. Your child will need to exercise for 30 minutes 3-6 times a week. You and your child will continue to meet with the WATCH clinic team and the surgeons after surgery.

What care is needed at home after surgery?

• Care of the incision: The tiny laparoscopic holes (probably 3-5) need minimal care. You may remove the plastic tape and gauze 3 days after surgery. There will be thin pieces of paper tape (Steri-Strips®) over the incisions. The Steri-Strips® should stay on until they fall off on their own.
• Bathing: Your child can shower after surgery, but the incision sites should be kept covered for at least 3 days. After 3 days, the patient may take tub baths.
• Activity limitations: There are no activity limitations. Your child will tire easily, but it is safe for them to do any activity that they did before the surgery.
• Diet: Lap-band patients have extensive instructions on their postoperative diet. In addition to the general guidelines listed above, please refer all questions to the nutritionist whom you met with before the surgery.
• Medication: With laparoscopic surgeries, there is minimal pain after the operation. By the day after surgery, liquid Tylenol or an occasional oral, mild narcotic is all that is necessary. If your child's pain does not get better with these medications, or if pain returns, please contact your surgeon immediately.
• Follow-up: You will have a follow-up appointment with your surgeon 2 weeks after your operation. To make an appointment, please call 415-476-2538.
• Complications after surgery: Please call us if you develop any of the following: fever, increased pain or pain that is not controlled with prescribed medications, bleeding, vomiting, diarrhea, or dehydration.