FTP5.4 Ethical Considerations Within Paediatric Bariatric Surgery: A Systematic Review
Aishwarya Shah, Niraj Kumar- Surgery
Abstract
Aims
With childhood obesity prevalence increasing rapidly, bariatric surgery is being given greater consideration in the paediatric population. Paucity of long-term evidence, physical and emotional risks, and reliance on parental decision-making are factors constituting this moral complexity, forming debate around eligibility and timing of offering the procedure. To evaluate these ethical considerations, a systematic review was conducted.
Methods
All relevant synonyms of “Ethics”, “Bariatric Surgery” and “Paediatric” were used to identify papers for inclusion in the systematic review and reference lists were also scanned. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
Results
10 papers were included. A key ethical dilemma frequently explored was the issue of consent, and ensuring the child is at the forefront of the decision. Paediatric bariatric surgery causes controversy as children are exposed to surgical risk early in life, and thus prolonged preventative measures are encouraged with the aim to mitigate obesity by adulthood causing unnecessary harm. Children without a strong support network have additional obesity risk, whereby withholding surgery may be viewed as inequitable and non-beneficent. There is also conflict between delaying surgery until the child is Fraser-competent versus increased complication risk.
Conclusions
Further evidence to guide assessment criteria are needed to facilitate informed consent. Post-operative support should be audited, with sustained health outcomes and inclusive care monitored. Although preventative methods are important in the paediatric population, clinicians must not discriminate against those for whom it proves ineffective, with bariatric surgery being a last resort for high-risk obese patients.