Most recent update: Thursday, November 30, 2017 - 11:56

Bariatric News - Cookies & privacy policy

You are here

Surgery in older patients

Bariatric surgery safe and effective in older patients

In morbid elderly patients, both surgeries achieved good weight loss and resolution of comorbidities

A study comparing the outcomes from laparoscopic Roux–en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in patients aged more than 55 years has concluded that both procedures  achieve good weight loss and resolution of comorbidities, and although bypass is superior in terms of diabetes remission it does have a higher complication rate even at high volume centres. Published in The Journal of Biomedical Research, the study sought to provide much needed comparative data in the elderly population, by reporting the safety and efficacy of LRYGB and LSG in patients aged more than 55 years.

The researchers undertook a retrospective review of the prospectively collected database from a high surgical volume centre, E-Da Hospital, Kaohsiung City, Taiwan, between January 2008 and December 2011.

The study gathered data on 68 patients (46 females) aged more than 55 years who had a mean age of 58.88 years (55–79 years) and a mean preoperative BMI39.5 (32.00–60.40 kg/m2). LRYGB was performed in 44 patients and LSG in 24 patients. The two groups were comparable in their preoperative BMI, ASA score and gender distribution. The patients undergoing LSG were significantly older than LRYGB and the percentage of associated type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients (88.63% vs. 50%; p<0.01).

There was no significant difference in the mean duration of diabetes (80.3 vs. 84 months; p= 0.860), preoperative FBS (149.46 vs. 132.3 mg/dL; p=0.416), HbA1c (7.79 vs. 7.86 gram%; p=0.859) and C–peptide levels (3.32 vs. 3.54; p=0.709) between the two groups. The prevalence of other co-morbidities was similar and comparable among the groups. Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 and 28.2, respectively; otherwise, there was no statistically significant difference in mean %EWL at one year between the two groups.

The percentage of resolution of diabetes (HbA1c<6.5% and FBS<100 mg/dl) was significantly higher in the LRYGB patients (69.2%) as compared to LSG patients (33.3%), P < 0.001. The glycaemia parameters and C–peptide levels were also lower after LRYGB than LSG, but did not reach a statistically significant level. All the comorbidities were significantly reduced after both operations one year postoperatively. There was no statistical difference in percentage of resolution of hypertension (56% vs. 60%; p=0.286), hyperlipidaemia (81.2% vs. 75%; p=0.792) and fatty liver hepatitis (76.9% vs. 62.5%; p=0.347) (Table 2). They also found that the diabetes remission group (DR) had a significantly higher % EWL compared with diabetes non remission group (DNR). Eight patients receiving LSG even reached 65.01% EWL in average; they still could not achieve remission of diabetes.

The mean operative time was significantly higher in LRYGB than LSG (103.97 vs. 70.04 minutes; p=0.0015). However, there was no significant difference in the mean length of hospital stay (2.54 vs. 2.21 days; p=0.834). The overall morbidity and re-operation rate was 14.71% and 11.8%, respectively. It was 20.45% and 15.9% for LRYGB and 4.2% and 4.2% for LSG patients. There was one mortality from gastrojejunostomy leakage in patients undergoing LRYGB. There was no statistically significant difference in these parameters. In the LRYGB group, there were nine complications (six early and three late), seven of which required re-operation.

“Elderly patients have more associated comorbidities which may account for the higher surgical risk and increased postoperative morbidity, and these patients have much decreased physiological reserves to tolerate, resulting in increased mortality after such events…” the researchers write. “We observed an overall mortality rate of 1.5%, which may be due to the fact that all primary surgeries and reoperations in our centre were undertaken by the laparoscopic approach, which may have contributed to a faster recovery. The rapid propagation of minimally invasive approach and comprehensive perioperative care would make bariatric surgery in elderly patients feasible and safer in the near future.”

They note that in morbid elderly patients, both surgeries achieved good weight loss and resolution of comorbidities, and LRYGB was superior to LSG in terms of diabetes remission but carried a higher complication rates even at high volume centres.

To access this paper, please click here

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.