**3.2 Adolescents**

Severe obesity in adolescents is associated with multiple comorbidities such as T2DM, hypertension, sleep apnea, fatty liver disease, decreased QoL and cardiovascular mortality in adulthood [54]. LSG has become the most used operation among

*Laparoscopic Sleeve Gastrectomy: Outcomes, Safety and Complications DOI: http://dx.doi.org/10.5772/intechopen.94534*

adolescents with severe obesity mainly because of comparable WL outcomes and morbidities resolution to RYGB [55]. Moreover, LSG carries lower risk of surgical and nutritional complications [55, 56]. Indications for BS in adolescents largely mirrors the recommendations for adults [54]. There are no data to suggest that a youth's puberty status or linear growth is adversely affected by BS. A study showed improved linear growth in children after LSG compared with matched controls [57]. LSG results is significant WL, with EWL% at one year ranging from 49% to 81% [56, 58], and with durable long term WL (78%) (5 years)[58]. In terms of comorbidities, surgical treatment of adolescents with severe obesity and T2DM resulted in superior glycemic control than medical treatment. Across two different studies, the Teen-Longitudinal Assessment of BS (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) study, a comparison of the glycemic control data showed that at 2 years, the mean hemoglobin A1c concentration decreased from 6.8% to 5.5% in Teen-LABS and increased from 6.4% to 7.8 in the TODAY study [55]. At 5 years post LSG, the remission rate of insulin resistance and T2DM was 100% and 87% respectively [58]. LSG also has a favorable outcome in terms of improvement of nonalcoholic steatohepatitis (NASH) [59]. Among adolescents who underwent LSG, NASH reverted completely in all patients and hepatic fibrosis stage 2 disappeared in 90% of the patients [59]. Moreover, LSG resulted in marked and sustained improvements in HRQoL, weight-related QoL and body image satisfaction [55, 60].

#### **3.3 Low BMI**

BS promotes marked and durable resolution of the clinical manifestations of diabetes in morbidly obese patients with T2DM. However, among Asians, the risks associated with T2DM and cardiovascular disease occur at a lower BMI than in Whites [61]. Patients with BMI < 35 kg/m<sup>2</sup> who have uncontrolled and lifethreatening comorbidities do not meet the traditional criteria for obesity surgery. A surgical approach may be appropriate as an alternative for inadequately controlled T2DM in suitable surgical candidates with mild to moderate obesity (BMI 30–35 kg/m<sup>2</sup> ) [62].
