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Surgical interventions provide a dependable approach for achieving sustained weight loss. This systematic review evaluated the effectiveness and safety of various bariatric procedures in severely obese children and adolescents. It focused on weight reduction, comorbidity resolution, postoperative complications and factors influencing the surgical decision-making process. Registered with INPLASY (INPLASY202650119), this review followed the PRISMA guidelines. PubMed, Scopus and Cochrane databases were searched until August 2024 for English-language studies, published between January 2005 and August 2024, enrolling adolescents aged 12\u201319 years who underwent bariatric surgery. Risk of bias was assessed using the NOS and EPHPP tools and data were synthesized qualitatively. A total of 39 articles fulfilled the eligibility criteria, including 33 observational studies, three randomized controlled trials and three clinical trials, encompassing 7,375 participants (4,770 female\u20131,591 male). Risk of reporting bias was deemed low. Roux-en-Y gastric bypass (RYGB) offers substantial weight loss and comorbidity resolution but carries higher micronutrient deficiency risks. Laparoscopic adjustable gastric banding (LAGB), while less invasive, is associated with higher reoperation rates and less durable weight loss. Sleeve gastrectomy (SG) is a viable alternative with fewer complications but may be less effective for diabetes remission. The decision to undergo surgery is multifactorial, shaped by medical necessity, financial and geographical accessibility and psychosocial determinants. In conclusion, bariatric surgery is an effective intervention for severe pediatric obesity, achieving significant weight reduction and metabolic improvements. Procedure selection should be individualized, weighing risks and benefits. Ongoing research and long-term follow-up are essential to optimize surgical outcomes and patient care.<\/jats:p>","DOI":"10.1007\/s42000-026-00809-9","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T18:16:22Z","timestamp":1783966582000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of bariatric techniques in the management of pediatric and adolescent obesity: a systematic review"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9253-3438","authenticated-orcid":false,"given":"Maria","family":"Athanasopoulou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4300-7061","authenticated-orcid":false,"given":"George","family":"Paltoglou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0851-6998","authenticated-orcid":false,"given":"Evangelia","family":"Charmandari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"809_CR1","unstructured":"Balasundaram P, Avulakunta ID (2023) Human Growth and Development. 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