Arnaud basdevant

Rencontres Endocrinologie GHU Chirurgie chez de l’obésité chez les jeunes Arnaud Basdevant Trousseau : Patrick Tounian B Dubern M Dreyfus Hôtel Dieu/Cochin : JL Bouillot M Samama Pitié : K Clément JM Oppert Ch Poitou D Tholliez

Prevention and Treatment of Pediatric Obesity Clinical Practice Guideline JCEM 2008 Best practice update for pediatric/adolescent bariatric surgery JS Pratt Obesity 2009

Perte de poids SOS Study Sjöström et al. NEJM , 2007 Control: 0% Anneaux: -13% VGB: -18 % GBP: -27 %

Arguments pour opérer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications ,[object Object],[object Object],[object Object]

Contre indications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Combien de jeunes concernés ?

Chirurgie bariatrique adolescent : USA ,[object Object],[object Object],[object Object],[object Object],[object Object],Treadwell JR Annals of Surgery 2008 Tsai Arch Pediatr Adolesc Med. 2007

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005-2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Jen HC , Pediatrics 2010.

environ 50 / an 1000 / 1 an Opérés 15 % : 2.2 M 37 % : 25 M Obèses ado 15 M 75 M 25% < 18 ans 60 M 300 M Population France USA

Registre SOFFCO ,[object Object],communication Jean Mouiel

Expérience Hôtel Dieu/ Trousseau / Pitié ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Meta analyse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treadwell et al Annals of Surgery, 2008

GBP: suivi 1 à 6 ans AGB: suivi 1 à 3 ans Treadwell et al Annals of Surgery, 2008 Réduction de l’IMC

Complications chirurgicales ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treadwell et al , Ann Surgery 2008

Amélioration des comorbidités ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treadwell et al Annals of Surgery, 2008

Diabetes and bariatric surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Inge TH Pediatrics. 2009 .

Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents Paul E. O’Brien & John B. Dixon JAMA. 2010;303(6):519-526.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Résultats à 2 ans ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

En résumé ,[object Object],[object Object],[object Object],[object Object],[object Object]

PB à résoudre ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IMC post chirurgie : de 12 à 20 ans Hôtel Dieu Trousseau Pitié DNID DNID DNID

Physicians’ opinions regarding the minimum age at which bariatric surgery should be considered in boys and girls

Physicians’ opinions regarding the length of time adolescents should participate in a monitored weight management program prior to undergoing bariatric surgery

Consentement ,[object Object],[object Object],[object Object],[object Object],[object Object]

Quelle technique ? Thaler, J. P. et al. Endocrinology 2009;150:2518-2525

Comment , où et par qui faire opérer ? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Equipe ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Suivi durable ,[object Object],[object Object],[object Object],[object Object],[object Object]

Adhésion aux conseils et au suivi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Concentric pouch dilatation because of a narrow stoma . . Contrast material enters the gastric fundus ( F ). Dilated pouch ( P ), narrow stoma

Complications du by pass ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]

Arnaud basdevant

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