Experiences with Laparoscopic Adjustable Gastric banding (LAGB) and Sleeve Gastrectomy (SG) in the treatment of patients with childhood craniopharyngioma and morbid obesity

Craniopharyngiomas are benign embryogenic malformations which arise from ectoblastic remnants of Rathke's pouch and can be found anywhere along the development path of Rathke's pouch in hypothalamic and pituitary regions – both of importance in endocrine regulation and satiety modulation.

According to the German multicenter surveillance study on childhood craniopharyngioma (KRANIOPHARYNGEOM 2000) obesity is present in up to 52% of patients, with at least half of these patients having difficulty controlling their desire to eat. The experience with laparoscopic adjustable gastric banding (LAGB) in extremely obese patients with childhood craniopharyngioma is limited.

We are reporting on four patients with childhood craniopharyngioma diagnosed at age 2, 11, 12, and 18 years. BMI-SDS at diagnosis was +0.9, +4.7, +4.5 and +0.2 SD. During follow-up, all patients developed morbid obesity (BMI-SDS: +10.9, +11.4, +10.4, +6.2) so that 12, 10, 5 and 3 years after diagnosis LAGB were performed. After a follow-up of 1.9, 1.0, 0.5 and 0.7 years BMI decreased continuously in all patients by –4.0, –3.7, –0.9 and –1.3 SDS. The eating behavior changed in all patients profoundly. The addiction to food and especially sweets significantly improved based on self-assessment. Quality of life and functional capacity as measured by FMH scale were not impaired after LAGB. At further follow-up (7.3, 5.3, 3.3 and 2.2 years after LAGB) all patients presented with weight gain (BMI SD increase by +3.2, +3.0, +1.5 and +1.7). At last evaluation, weight reduction consolidated at –0.8, –0.7, +0.6 and +0.4 δ BMI-SDS.

In three patients a dislocation of the LAGB occurred and resulted in significant weight gain, which resolved after laparoscopic revision in two of them. One adult patient had a gastric-sleeve resection after removal of gastric banding, which was performed without complications. Post-operative BMI decreased from 6.62 SD to 5.01 SD during two months. During follow-up there was a weight gain of 1.6 BMI-SDS which resolved (BMI decreased by 1.4 SD) during life style intervention for seven months.

Bariatric surgery like LAGB or gastric-sleeve resection could be effective in weight reduction of obese craniopharyngioma patients when combined with intensive nutritional counceling and psychological support. Analysis of gastro-intestinal endocrine factors and long-term follow-up of weight development after LAGB is part of the prospective multicenter study KRANIOPHARYNGEOM 2007 (www.kranipopharyngeom.net) in order to test the hypothesis that LAGB might be a therapeutic option in craniopharyngioma.