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IPEG guidelines for surgical treatment of extremely obese adolescents.

Extreme obesity has become a significant health problem for the pediatric population,1 and has prompted considerable discussion about optimal management.2 In some, the health effects are serious enough to provide compelling reasons to consider bariatric surgery.3 This document represents a clinical practice guideline, based on review of the evidence, issued by the International Pediatric Endosurgery Group (IPEG). This document is not intended to summarize the published evidence relevant to adolescent bariatric surgery, as a health technology assessment (systematic review) has been done.4 The current recommendations are based largely upon the literature reviewed within the health technology assessment and on other guidelines published in Obesity Research in 20055 and updated in 2009.6 This guideline is, therefore, a synopsis, intended to guide surgeons who are contemplating the use of bariatric surgery for adolescents. Most recommendations were based on data extrapolated from adult studies, descriptive studies focused on adolescents, and expert opinions. The grading system used is shown in Table 1.