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Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial)

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Obesity Surgery Aims and scope

Abstract

Purpose

Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes.

Objectives

This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older.

Methods

Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions.

Results

The median age (67 × 67 years; p=0.67) and initial body mass index (BMI) (46.3 × 51.3 kg/m2; p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 × 47.6 kg/m2; p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 × 68%; p=0.04; 24.9 × 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (−1.1 × −0.5%; p<0.01) as well as LDL control (−27.5 × +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality.

Conclusion

Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.

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Data Availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Bloom DE, Canning D, Fink G. Implications of population ageing for economic growth. Oxf Rev Econ Policy. 2010;26(4):583–612.

    Article  Google Scholar 

  2. Lutz W, Sanderson W, Scherbov S. The coming acceleration of global population ageing. Nature. 2008;451(7179):716–9.

    Article  CAS  Google Scholar 

  3. Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. Jama. 2012;307(5):491–7.

    Article  Google Scholar 

  4. Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol. 2017;2(7):e17.

    Article  Google Scholar 

  5. Gomez-Cabello A, Pedrero-Chamizo R, Olivares PR, et al. Prevalence of overweight and obesity in non-institutionalized people aged 65 or over from Spain: the elderly EXERNET multi-centre study. Obes Rev. 2011;12(8):583–92.

    Article  CAS  Google Scholar 

  6. Jésus P, Guerchet M, Pilleron S, et al. Undernutrition and obesity among elderly people living in two cities of developing countries: prevalence and associated factors in the EDAC study. Clin Nutri ESPEN. 2017;21:40–50.

    Article  Google Scholar 

  7. Contreras JE, Santander C, Bravo J. Correlation between age and weight loss after bariatric surgery. Obes Surg. 2013;23(8):1286–9.

    Article  Google Scholar 

  8. Robert M, Pasquer A, Espalieu P, et al. Gastric bypass for obesity in the elderly: is it as appropriate as for young and middle-aged populations? Obes Surg. 2014;24(10):1662–9.

    Article  Google Scholar 

  9. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  CAS  Google Scholar 

  10. Peterli R, Borbély Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258(5):690–5.

    Article  Google Scholar 

  11. Pajecki D, Dantas AC, Kanaji AL, et al. Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial). Surg Obes Relat Dis. 2020;7

  12. Cotillard A, Poitou C, Duchâteau-Nguyen G, et al. Type 2 Diabetes Remission After Gastric Bypass: What Is the Best Prediction Tool for Clinicians? Obes Surg. 2015;25(7):1128–32.

    Article  Google Scholar 

  13. Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11(1):32.

    Article  Google Scholar 

  14. Pechman DM, Flores FM, Kinkhabwala CM, et al. Bariatric surgery in the elderly: outcomes analysis of patients over 70 using the ACS-NSQIP database. Surg Obes Relat Dis. 2019;15(11):1923–32.

    Article  Google Scholar 

  15. Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24(5):1005–10.

    Article  CAS  Google Scholar 

  16. Ruiz-Tovar J, Carbajo MA, Jimenez JM, et al. Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities. Surg Endosc. 2019;33(2):401–10.

    Article  Google Scholar 

  17. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627.

    PubMed  PubMed Central  Google Scholar 

  18. O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg. 2010;20(9):1199–205.

    Article  Google Scholar 

  19. Pajecki D, Santo MA, Joaquim HD, et al. Bariatric surgery in the elderly: results of a mean follow-up of five years. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2015;28:15–8.

    Article  Google Scholar 

  20. Li J, Lai D, Wu D. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2016;26(2):429–42.

    Article  Google Scholar 

  21. Wu C, Bai R, Yan W, et al. Clinical outcomes of one anastomosis gastric bypass versus sleeve gastrectomy for morbid obesity. Obes Surg. 2020;30(3):1021–31.

    Article  Google Scholar 

  22. Khalaj A, Tasdighi E, Hosseinpanah F, et al. Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS). BMC Surg. 2020;20(1):1–4.

    Article  Google Scholar 

  23. Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. Jama. 2018;319(3):241–54.

    Article  Google Scholar 

  24. Pajecki D, Santo MA, Kanagi AL, et al. Functional assessment of older obese patients candidates for bariatric surgery. Arq Gastroenterol. 2014;51(1):25–8.

    Article  Google Scholar 

  25. Vargas CB, Picolli F, Dani C, et al. Functioning of obese individuals in pre-and postoperative periods of bariatric surgery. Obes Surg. 2013;23(10):1590–5.

    Article  CAS  Google Scholar 

  26. Vinan-Vega M, Vico TD, Elli EF. Bariatric surgery in the elderly patient: safety and short-time outcome. A case match analysis. Obes Surg. 2019;29(3):1007–11.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Bariatric and Metabolic Surgery Unit, Discipline of Gastroenterology, Universidade de São Paulo, Sao Paulo, Brazil

    Denis Pajecki, Anna Carolina Batista Dantas, Francisco Tustumi, Roberto de Cleva & Marco Aurelio Santo

  2. Discipline of Gastroenterology, Universidade de São Paulo, Sao Paulo, Brazil

    Francisco Tustumi

  3. Division of Geriatrics, Department of Internal Medicine, Universidade de São Paulo, Sao Paulo, Brazil

    Ana Lumi Kanaji

Authors
  1. Denis Pajecki
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  2. Anna Carolina Batista Dantas
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  3. Francisco Tustumi
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  4. Ana Lumi Kanaji
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  5. Roberto de Cleva
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  6. Marco Aurelio Santo
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Contributions

Conception and design of the work: all authors.

Drafting the manuscript: Dr Pajecki and Dr Dantas.

Critical review of the manuscript for important intellectual contents: all authors.

Manuscript Supervision: Dr Pajecki and Dr Santo.

Approval of the version to be published: all authors.

We certify that all authors of this manuscript have participated in conceptualizing the research or content of the manuscript, in writing or critically editing the manuscript, and/or in analysis of data presented in the manuscript. Consent to submit has been received from all co-authors.

Corresponding author

Correspondence to Francisco Tustumi.

Ethics declarations

Statement of Human and Animals Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethics Approval

The local ethics committee approved the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Key Points

• Bariatric surgery in the elderly remains controversial.

• Obese aged patients were recruited for an open-label randomized trial.

• Sleeve gastrectomy was compared with gastric bypass.

• Weight loss, diabetes and LDL control were better achieved with gastric bypass.

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Pajecki, D., Dantas, A.C.B., Tustumi, F. et al. Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial). OBES SURG 31, 2359–2363 (2021). https://doi.org/10.1007/s11695-021-05316-x

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  • DOI: https://doi.org/10.1007/s11695-021-05316-x

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