Long-term outcome after robotic-assisted gastroplication in adolescents: Hunger hormone and food preference changes two case reports

Weight loss surgery (WLS) is efficacious for long- term weight reduction and decreases overall mortality in severely obese patients. The mechanisms implicated in long- term weight loss are not fully understood. Proposed mechanisms include changes in gut hormones and brain regulation of appetite and satiety. We aimed to investigate the long- term ghrelin and leptin profiles and changes in food preference and eating behavior after WLS in adolescent patients. Two obese females aged 15 years and 14 4/12 years, who did not respond to lifestyle changes, including dietary intervention and physical exercise in combination with medical therapy, underwent roboticassisted gastroplication. Anthropometric measurements, food habits and eating behavior, as well as metabolic and hormonal changes during long- term post- surgical follow- up were monitored. Long- term weight reduction was obtained in both patients, with a significant decrease in waist circumference. Resting energy expenditure showed a decrease over time, with a respiratory quotient that increased showing a shift from oxidation of a high- fat diet before surgery to oxidation of a mixed diet two and three years later. Both subjects improved their eating habits and lifestyle. Comorbidity resolution was also noted. Increased pre- prandial ghrelin levels as well as higher post- prandial ghrelin and a leptin drop compared with pre- surgery values were observed in both patients. Persistent weight loss after gastroplication is associated with a favorable change in gut hormones and food preferences. The role of hormonal and sensory components in long- term results seems crucial. Particularly in adolescent patients, a multidisciplinary approach and continuous nutritional care is mandatory for weight maintenance and consolidation of changes.