Obesity Surgery

, Volume 21, Issue 8, pp 1180–1187

Laparoscopic Sleeve Gastrectomy in Patients over 59 Years: Early Recovery and 12-Month Follow-Up

  • Marja Kaarina Leivonen
  • Anne Juuti
  • Nabil Jaser
  • Harri Mustonen
Clinical Research

Abstract

Background

Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder.

Methods

Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1- and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared.

Results

The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p = ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p = 0.02), but late complications were more common in younger patients, 17% vs 44%, p = ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p = ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p = ns.

Conclusions

Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and hypoalbuminemia. Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein.

Keywords

Sleeve gastrectomy Bariatric surgery Elderly age groups Vitamin deficiency 

References

  1. 1.
    Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004;240:243–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Fatima J, Houghton SG, Iqbal CW, et al. Bariatric surgery at the extremes of age. J Gastrointest Surg. 2006;10:1392–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.PubMedGoogle Scholar
  4. 4.
    Dunkle-Blatter SE, St Jean MR, Whitehead C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obesity Rel Dis. 2007;3(2):163–9.CrossRefGoogle Scholar
  5. 5.
    Wittgrove AC, Martinez T. Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities. Obes Surg. 2009;19:1472–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Quebbemann B, Engstrom D, Siegfried T, et al. Bariatric surgery in patients older than 65 years is safe and effective. Surg Obesity Rel Dis. 2005;1(4):389–2.CrossRefGoogle Scholar
  7. 7.
    Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg. 2010;20(1):1–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15(8):1124–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Jacobs M, Bisland W, Gomez E, et al. Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc. 2010;24(4):781–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multi-center study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Menenakos E, Stamou KM, Albanopoulos K. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg. 2010;20(3):276–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Frezza EE, Reddy S, Gee LL, et al. Complications after sleeve gastrectomy for morbid obesity. Obes Surg. 2009;19:684–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25:88–97.PubMedCrossRefGoogle Scholar
  14. 14.
    Himpens J, Dapri G, Gadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8:487–99.PubMedCrossRefGoogle Scholar
  17. 17.
    St Peter SD, Craft RO, Tiede JL, et al. Impact of advanced age on weight loss and health benefits after laparoscopic gastric bypass. Arch Surg. 2005;140:165–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Mittermair RP, Aigner F, Obermüller S. Results and complications after Swedish adjustable gastric banding in older patients. Obes Surg. 2008;18(12):1558–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Nehoda H, Hourmont K, Sauper T, et al. Laparoscopic gastric banding in older patients. Arch Surg. 2001;136(10):1171–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Flum DR, Salem L, Elrod JAB, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg. 2006;141:1115–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145(1):106–13.PubMedCrossRefGoogle Scholar
  23. 23.
    Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis. 2010;6(2):146–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Iannelli A, Schneck AS, Ragot E, et al. Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty. Obes Surg. 2009;19(9):1216–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Uglioni B, Wolnerhanssen B, Peters T, et al. Midterm results of primary vs. secondary laparoscopic sleeve gastrectomy (LSG) as an isolated operation. Obes Surg. 2009;19(4):401–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Acholonu E, McBean E, Court I, et al. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg. 2009;19(12):1612–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Segal JB, Clark JM, Shore AD, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19:1646–56.PubMedCrossRefGoogle Scholar
  29. 29.
    Peterli R, Wolnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41.PubMedCrossRefGoogle Scholar
  30. 30.
    Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg. 2008;18(9):1077–82.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Schweiger C, Weiss R, Bery E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010;20(2):193–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Clements RH, Katasani VG, Palepu R, et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg. 2006;72(12):1196–2020.PubMedGoogle Scholar
  35. 35.
    Colossi FG, Casagrande DS, Chatkin R, et al. Need for multivitamin use in the postoperative period of gastric bypass. Obes Surg. 2008;18(2):187–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Gong K, Gagner M, Pomp A, et al. Micronutrient deficiencies after laparoscopic gastric bypass: recommendations. Obes Surg. 2008;18(9):1062–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.PubMedCrossRefGoogle Scholar
  38. 38.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Marja Kaarina Leivonen
    • 1
    • 2
  • Anne Juuti
    • 1
    • 2
  • Nabil Jaser
    • 1
    • 2
  • Harri Mustonen
    • 1
    • 3
  1. 1.Department of SurgeryHelsinki University Central HospitalHelsinkiFinland
  2. 2.HUCHPeijas HospitalVantaaFinland
  3. 3.HUCHMeilahti HospitalHelsinkiFinland

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