Dr. Janey S.A. Pratt, MD, FACS, FASMBS is a general surgeon who specializes in Robotic Hernia repair and Metabolic and Bariatric Surgery (MBS). She began her career in general surgery at Massachusetts General Hospital, where she was a founding member of the MGH Weight Center. As surgical director she introduced minimally invasive MBS and adolescent MBS to MGH in 2001 and 2007 respectively. In 2011 Dr. Pratt took over as Director at the MGH Weight Center and continued to work on several national committees towards improving access and care of adolescents with severe obesity. Dr. Pratt continued to practice general surgery through out her tenure at MGH seeing patients with breast cancer, hernias, and obesity. She performed advance minimally invasive surgery(MIS) as well as advanced endoscopy.
In 2016 Dr. Pratt moved to California where she began her work at Stanford University, splitting her time between the Lucille Packard Children’s Hospital and the Palo Alto VA. She performs Minimally Invasive MBS at both institutions as well as endoscopy. Dr. Pratt has trained in robotic surgery and performs robotic assisted hernia repairs on complex and simple hernias. As a Clinical Associate Professor of Surgery, Dr. Pratt is involved in training Stanford medical students and residents both in the OR, in the clinic, in the simulation labs and in the class room. Dr. Pratt is the associate program director of the VA MIS fellowship program, and Chair of the Pediatric Committee of the American Society for Metabolic and Bariatric Surgery.
Dr. Pratt has been involved in creating and updated guidelines for Adolescent MBS since 2005. In 2018 she was first author on the ASMBS Pediatric Metabolic and Bariatric Surgery Guidelines. Her other research interests include: MIS approaches to hernia repair and bowel obstruction, pediatric obesity treatment and the use of medications to improve outcomes of MBS. Dr. Pratt frequently lectures on the subject of Adolescent Metabolic and Bariatric Surgery.
- General Surgery
Medical Education: Tufts University School of Medicine Office of the Registrar (1993) MA
Board Certification: General Surgery, American Board of Surgery (1999)
Residency: Massachusetts General Hospital (1998) MA
Internship: Massachusetts General Hospital (1994) MA
Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery.
Seminars in pediatric surgery
2020; 29 (1): 150890
To ensure successful outcomes in pediatric patients with severe obesity who undergo metabolic and bariatric surgery (MBS), a number of pre-operative patient management options should be considered. This manuscript will review the indications and contraindications of MBS and special considerations for youth who might benefit from MBS. The treatment team conducts a thorough pre-operative evaluation, assessing risks and benefits of surgical intervention, and prepares patients and families to be successful with MBS by providing education about the surgical intervention and lifestyle changes that will be necessary. This article reviews the pre-operative considerations for adolescents with severe obesity who are being considered for MBS, based upon recent clinical practice guidelines.
View details for DOI 10.1016/j.sempedsurg.2020.150890
View details for PubMedID 32238283
Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery.METHODS: A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy.RESULTS: There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p=0.000) and steatosis (100.0% versus 59.4%, p=0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p=0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1mIU/L, p=0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p=0.033) and alanine aminotransferase (81.5 versus 52.7mg/dL, p=0.043). There were no biopsy complications or changes in management due to biopsy results.CONCLUSIONS: Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.
View details for DOI 10.1007/s11695-019-04136-4
View details for PubMedID 31446562
Slipped capital femoral epiphysis and Blount disease as indicators for early metabolic surgical intervention.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
BACKGROUND: Slipped capital femoral epiphysis (SCFE) and Blount disease are strongly associated with pediatric obesity, yet they have only recently been identified as indications for consideration of metabolic and bariatric surgery (MBS).OBJECTIVES: To describe the relationships between pediatric obesity, MBS, SCFE, and Blount disease.SETTING: Nationwide database.METHODS: The national inpatient sample was used to identify patients ≤20 years old with obesity who underwent MBS from 2007 to 2016. Presence of SCFE and Blount disease was similarly extracted.RESULTS: The overall prevalence of SCFE and Blount disease among patients ≤20 years old is .02% for both (14,976, 11,238 patients, respectively) with no statistically significant change over the study period (P = .68, .07, respectively). The rates of SCFE and Blount disease in children with and without obesity are .46% versus .02% and .36% versus .01%, respectively (P < .001 for both). The mean age of patients with SCFE and obesity was 12 years old, while the mean age of those without obesity was 12.2 years old (P = .03). None of the children with obesity and SCFE underwent MBS. Similarly, the mean age of patients with Blount disease and obesity was 12.6 years old, while the mean age of those without obesity was 13.1 years old. Moreover, the mean age of children with Blount disease and obesity who underwent MBS was 16 years old (P < .001).CONCLUSIONS: Orthopedic complications remain a persistent problem in the pediatric population who suffer from obesity. Despite being diagnosed at a young age, patients with SCFE and/or Blount disease are not undergoing MBS until their later adolescent years, potentially leading to unnecessary disease progression or recurrence of disease after orthopedic interventions. Therefore, SCFE and Blount disease should be considered indications for early consideration of MBS in this pediatric population.
View details for DOI 10.1016/j.soard.2019.06.024
View details for PubMedID 31519488
Clinical Considerations Regarding the Use of Obesity Pharmacotherapy in Adolescents with Obesity.
Obesity (Silver Spring, Md.)
2019; 27 (2): 190–204
A growing number of youth suffer from obesity and in particular severe obesity for which intensive lifestyle intervention does not adequately reduce excess adiposity. A treatment gap exists wherein effective treatment options for an adolescent with severe obesity include intensive lifestyle modification or metabolic and bariatric surgery while the application of obesity pharmacotherapy remains largely underutilized. These youth often present with numerous obesity-related comorbid diseases, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and psychosocial issues such as depression, anxiety, and social stigmatization. Current pediatric obesity treatment algorithms for pediatric primary care providers focus primarily on intensive lifestyle intervention with escalation of treatment intensity through four stages of intervention. Although a recent surge in the number of Food and Drug Administration-approved medications for obesity treatment has emerged in adults, pharmacotherapy options for youth remain limited. Recognizing treatment and knowledge gaps related to pharmacological agents and the urgent need for more effective treatment strategies in this population, discussed here are the efficacy, safety, and clinical application of obesity pharmacotherapy in youth with obesity based on current literature. Legal ramifications, informed consent regulations, and appropriate off-label use of these medications in pediatrics are included, focusing on prescribing practices and prescriber limits.
View details for PubMedID 30677262
- Clinical Considerations Regarding the Use of Obesity Pharmacotherapy in Adolescents with Obesity OBESITY 2019; 27 (2): 190–204
- Comment on: body contouring in adolescents after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 2019
National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity.
View details for PubMedID 30357351
- Weight Loss Medications in Older Adults After Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multicenter Study BARIATRIC SURGICAL PRACTICE AND PATIENT CARE 2018
Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study.
Children (Basel, Switzerland)
2018; 5 (9)
This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or metformin postoperatively. Percentage of patients achieving ≥5%, ≥10%, or ≥15% weight loss on medications was determined and percent weight change on each medication was compared to percent weight change of the rest of the cohort. Our results showed that 54.1% of study patients lost ≥5% of their postsurgical weight; 34.3% and 22.9% lost ≥10% and ≥15%, respectively. RYGB had higher median percent weight loss (-8.1%) than SG (-3.3%) (p = 0.0515). No difference was found in median percent weight loss with medications started at weight plateau (-6.0%) versus after weight regain (-5.4%) (p = 0.5304). Patients taking medications at weight loss plateau lost 41.2% of total body weight from before surgery versus 27.1% after weight regain (p = 0.076). Median percent weight change on metformin was -2.9% compared to the rest of the cohort at -7.7% (p = 0.0241). No difference from the rest of the cohort was found for phentermine (p = 0.2018) or topiramate (p = 0.3187). Topiramate, phentermine, and metformin are promising weight loss medications for 21 to 30 year olds. RYGB patients achieve more weight loss on medications but both RYGB and SG benefit. Median total body weight loss from pre-surgical weight may be higher in patients that start medication at postsurgical nadir weight. Participants on metformin lost significantly smaller percentages of weight on medications, which could be the result of underlying medical conditions.
View details for PubMedID 30158481
ASMBS pediatric metabolic and bariatric surgery guidelines, 2018.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
2018; 14 (7): 882–901
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.
View details for PubMedID 30077361
Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study
WORLD JOURNAL OF GASTROENTEROLOGY
2018; 24 (19): 2108–19
To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment.One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved (P < 0.0001). The medication domain was not changed in the CPA treated group (P = 0.176).CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.
View details for PubMedID 29785079
View details for PubMedCentralID PMC5960816
Weight Loss Medications in Older Adults After Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multicenter Study.
Bariatric surgical practice and patient care
2018; 13 (4): 171–78
Weight loss medications are effective to confer additional weight loss after bariatric surgery in the general population, but they have not been evaluated in adults 60 years of age and older. We performed a retrospective study identifying 35 patients who were ≥60 years old and had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2000 to 2014, and were subsequently prescribed weight loss medications. Linear regression analyses were performed to determine beta coefficients of certain predictor variables being associated with weight loss. Patients lost weight on medications with an average body mass index (BMI) change of -2.74 kg/m2, standard deviation = 2.6 kg/m2. RYGB patients lost a greater percentage of BMI on medication than SG (SG; -1.38 ± 1.49 kg/m2 and RYGB; -3.37 ± 2.83 kg/m2, p = 0.0372). Patients with hypertension were less likely to lose weight on medications (β = 16.76, p = 0.004, and 95% confidence interval = 5.85-27.67). Weight loss medications are a useful treatment to confer additional weight loss in adults 60 years of age and older after RYGB and SG.
View details for PubMedID 30595995
View details for PubMedCentralID PMC6306651
A multidisciplinary approach to laparoscopic sleeve gastrectomy among multiethnic adolescents in the United States.
Journal of pediatric surgery
Childhood obesity has become a serious public health problem in our country with a prevalence that is disproportionately higher among minority groups. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for severely obese adolescents.A retrospective study on morbidly obese adolescents that underwent LSG at our institution from 2009 to 2017. Primary outcomes were weight loss as measured by change in BMI and percent excess weight loss (%EWL) at 1 year after surgery, resolution of comorbidities and occurrence of complications.Thirty-eight patients, of whom 71% were female and 74% were ethnic minorities, underwent LSG between 2009 and 2016. Mean age was 16.8years, mean weight was 132.0kg and mean BMI was 46.7. There were no surgical complications. Mean %EWL was 19.4%, 27.9%, 37.4%, 44.9%, and 47.7% at 1.5, 3, 6, 9, and 12month follow up visits, respectively. Comorbidity resolution rates were 100% for hypertension and nonalcoholic fatty liver disease, 91% for diabetes, 44% for prediabetes, 82% for dyslipidemia and 89% for OSA.LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. Further studies are needed to investigate the long-term effects of LSG in adolescents.Descriptive case series with prospective database.IV.
View details for PubMedID 28697852