Preoperative Characteristics of Adolescents Undergoing Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass.

INTRODUCTION

Sleeve gastrectomy (SG) has become the predominant metabolic and bariatric surgery procedure in adolescents in the United States, whereas Roux-en-Y gastric bypass (RYGB) is performed less often. Although both operations are established treatment options, contemporary data clarifying how adolescents are selected for RYGB versus SG remain limited. In particular, it is unclear whether procedure choice is associated primarily with BMI, obesity-related disease burden, or demographic factors. We compared preoperative characteristics of adolescents undergoing RYGB versus SG and identified factors independently associated with RYGB.

METHODS

We analyzed the 2021-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, restricting to adolescents aged 13-18 years undergoing SG or RYGB. Demographics, BMI, obesity-related conditions, laboratory values, and procedure status were compared. Multivariable logistic regression estimated adjusted odds of RYGB.

RESULTS

Among 2,465 adolescents, 2,281 (92.6%) underwent SG and 184 (7.4%) underwent RYGB. RYGB patients were older (17.41 vs. 16.94 years) and more often female (79% vs. 68%). BMI distributions were similar between procedures, including preoperative BMI (48 vs. 47 kg/m²) and prevalence of BMI > 50 kg/m². GERD, hyperlipidemia, insulin-treated diabetes, any diabetes, and HbA1c were higher among RYGB patients. In the fully adjusted model, older age (OR 1.52; 95% CI 1.29-1.81), female sex, and higher associated medical problem count (OR 1.37; 95% CI 1.17-1.59) were associated with RYGB, whereas BMI was not.

CONCLUSION

RYGB was uncommon and concentrated among older, predominantly female adolescents with greater metabolic burden. BMI was similar between procedures and did not independently drive procedure selection.