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Gastric Bypass pp 151-157 | Cite as

Roux-en-Y Gastric Bypass in the Elderly Patient

  • Denis PajeckiEmail author
  • Andre Morrell
  • Marco Aurelio Santo
Chapter
  • 33 Downloads

Abstract

Bariatric surgery in the elderly has always been a paradigm and currently, the surgical treatment of obesity in patients over 65 years remains controversial, with a lack of specific criteria or outcomes that characterize the potential benefits. In general, older people lose less weight than younger adults lose, but have similar levels of comorbidity resolution. Particular endpoints in the elderly, such as improved functionality, reduced frailty, and improved quality of life, are most important. The presence of sarcopenia can be one of the factors that compromise the effectiveness of weight loss in this population. Roux-en-Y gastric bypass (RYGBP) has been the most common bariatric procedure performed in the elderly population. Surgical morbidity in patients over 60 years undergoing laparoscopic or conventional RYGBP is no different from that observed in younger patients. For those over 65 though, surgical morbidity and mortality is higher after open RYGBP. On the other hand, laparoscopic RYGBP is considered safe and effective for the elderly over 65, with similar morbidity and slight higher but acceptable rates of mortality.

Keywords

Obesity Treatment Elderly Surgery Bariatric Gastric bypass Weight loss Sarcopenia Geriatric Functionality Morbidity Mortality 

References

  1. 1.
    Rossner S. Obesity in the elderly – a future matter of concern? Obes Rev. 2001;2:183–8.CrossRefGoogle Scholar
  2. 2.
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in distribution of BMI among US adults, 1999–2010. JAMA. 2012;307(5):491–7.CrossRefGoogle Scholar
  3. 3.
    Brasil. Instituto Brasileiro de Geografia e estatística. Pesquisa de Orçamentos Familiares: 2008–2009. Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Bibli. Do Minist. Do Planejamento e Gestão. 2010. p. 130.Google Scholar
  4. 4.
    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.CrossRefGoogle Scholar
  5. 5.
    Lang IA, Llewellyn DJ, Alexander K, et al. Obesity, physical function and mortality in older adults. JAGS. 2008;56:1474–8.CrossRefGoogle Scholar
  6. 6.
    Scandrett KG, Zuckerbraun BS, Peitzman AB, et al. Operative risk stratification in the older adult. Sug Clin N Am. 2015;95:149–72.CrossRefGoogle Scholar
  7. 7.
    Snih SA, Ottenbacher KJ, Markides KS, et al. The effect of obesity on disability vs mortality in older americans. Arch Intern Med. 2007;167:774–80.CrossRefGoogle Scholar
  8. 8.
    Vliegen M, et al. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts. 2012;5:460–83.CrossRefGoogle Scholar
  9. 9.
    Mitchell RJ, Lord SR, Harvey LA, et al. Associations between obesity and overweight and fall risk, health status and quality of life in older people. Aust N Z J Public Health. 2014;38(1):13–8.  https://doi.org/10.1111/1753-6405.12152.CrossRefPubMedGoogle Scholar
  10. 10.
    Grabowski DC, Ellis JE. High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc. 2001;49(7):968–79.CrossRefGoogle Scholar
  11. 11.
    Losonczy KG, Harris TB, Cornoni-Huntley J, et al. Does weight loss from middle age to old age explain the inverse weight mortality relation in old age? Am J Epidemiol. 1995;141(4):312–21.CrossRefGoogle Scholar
  12. 12.
    Kennedy RL, Chokkalingham K, Srinivasan R. Obesity in the elderly: who should web e treating, and why, and how? Currnt Op Clin Nut Met Care. 2004;7:3–9.CrossRefGoogle Scholar
  13. 13.
    Shea MK, et al. ADAPT study. J Gerontol A Biol Sci Med Sci. 2010;65(5):519–25.CrossRefGoogle Scholar
  14. 14.
    Horie NC, Cercato C, Mancini MC, et al. Long term pharmacoterapy for obesity in the elderly patients. Drugs Aging. 2010;27:497–506.CrossRefGoogle Scholar
  15. 15.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.CrossRefGoogle Scholar
  16. 16.
    Brasil. Conselho Federal de Medicina RESOLUÇÃO CFM N° 1.766/05.Google Scholar
  17. 17.
    Yermilov I, McGory ML, Shekelle PW, et al. Appropriateness criteria for bariatric surgery: beyond the NIH guidelines. Obesity (Silver Spring). 2009;17(8):1521–7.CrossRefGoogle Scholar
  18. 18.
    De Luca M, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26:1659–96.CrossRefGoogle Scholar
  19. 19.
    Perry CD, Hutter MM, Smith DB, et al. Survival and changes in comorbidities after bariatric surgery. Ann Surg. 2008;247(1):21–7.CrossRefGoogle Scholar
  20. 20.
    Brolin RE, Cody RP, Marcella SW. Differences inn open versus laparoscopic gastric bypass mortality risk using the Obesity Surgery Mortality Risk Score (OS-MRS). SORD. 2015;11:1201–6.Google Scholar
  21. 21.
    St Peter SD, Craft RO, Tiede JL. Impact of advanced age on weight loss and health benefits after laparoscopic gastric bypass. Arch Surg. 2005;140(2):165–8.CrossRefGoogle Scholar
  22. 22.
    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.  https://doi.org/10.1007/s11695-010-0201-4.CrossRefPubMedGoogle Scholar
  23. 23.
    Batsis JA, Dolkart KM. Evaluation of older adults with obesity for bariatric surgery: geriatrician’s perspective. J Clin Geront Geriatr. 2015;6:45–53.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 25.
    Otto M, et al. Handgrip strength as a predictor for post bariatric body composition. Obes Surg. 2014;24:2082–8.CrossRefGoogle Scholar
  26. 26.
    Dunkle-Blatter SE, St Jean MR, Whitehead C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis. 2007;3(2):163–9.CrossRefGoogle Scholar
  27. 27.
    Hazzan D, Chin EH, Steinhagen E, et al. Laparoscopic bariatric surgery can be safe for treatment of morbid obesity in patients older than 60 years. Surg Obes Relat Dis. 2006;2(6):613–6.CrossRefGoogle Scholar
  28. 28.
    Hallowell PT, Stellato TA, Schuster M, et al. Avoidance of complications in older patients and Medicare recipients undergoing gastric bypass. Arch Surg. 2007;142:506–10.CrossRefGoogle Scholar
  29. 29.
    Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg. 2006;141(11):1115–20.CrossRefGoogle Scholar
  30. 30.
    Nelson LG, Lopez PP, Haines K, et al. Outcomes of bariatric surgery in patients > or =65 years. Surg Obes Relat Dis. 2006;2(3):384–8.CrossRefGoogle Scholar
  31. 31.
    Dorman RB, Abraham AA, Al-Rafaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP study. J Gastrointest Surg. 2012;16:35–44.CrossRefGoogle Scholar
  32. 32.
    Chow A, Switzer NJ, Gill RS, et al. Roux-en-Y gastric bypass in the elderly: a systematic review. Obes Surg. 2016;26:626–30.CrossRefGoogle Scholar
  33. 33.
    Quebbemann BB, Engstrom DR, Siegfried T, et al. Bariatric surgery in patients older than 65 years is safe and effective. Surg Obes Relat Dis. 2005;1:389–93.CrossRefGoogle Scholar
  34. 34.
    Pajecki D, Santo MA, Joaquim HD, et al. Bariatric surgery in the elderly: results of a mean follow-up of five years. Arq Bras Cir Dig. 2015;28(Suppl 1):15–8.CrossRefGoogle Scholar
  35. 35.
    Thereaux J, Poitou C, Barsamian C, et al. Midterm outcomes of gastric bypass for elderly patients: a comparative study. Surg Obes Relat Dis. 2015;11:836–41.CrossRefGoogle Scholar
  36. 36.
    Montastier E, Becouam G, Bérard E, et al. Gastric bypass in older patients: complications, weight loss and resolution of comorbidities at 2 years in a matched controlled study. Obes Surg. 2016;26:1806–13.CrossRefGoogle Scholar
  37. 37.
    Huang CK, Garg A, Kuau HC, et al. Bariatric surgery in old age: a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia center of excellence. J Biomed Res. 2015;29(2):118–24.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Sosa JL, Pombo H, Pallavicini H, et al. Laparoscopic gastric bypass beyond age 60. Obes Surg. 2004;14:1398–401.CrossRefGoogle Scholar
  39. 39.
    Wittgrove AC, Martinez T, et al. Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities. Obes Surg. 2009;19:1472–6.CrossRefGoogle Scholar
  40. 40.
    Willkomm CM, Fischer TL, Barnes GS, et al. Surgical weight loss > 65 years old: is it worth the risk? Surg Obes Relat Dis. 2010;6:491–7.CrossRefGoogle Scholar
  41. 41.
    Giordano S, Victorzon M, et al. Bariatric surgery in the elderly: a systematic review. Clin Interv Aging. 2015;10:1627–35.PubMedPubMedCentralGoogle Scholar
  42. 42.
    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;24:1662–9.CrossRefGoogle Scholar
  43. 43.
    Moon RC, Kreimer F, Teixeira AF, et al. Morbidity rates and weight loss after Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding in patients older than 60 years old: which procedure to choose? Obes Surg. 2016;26(4):730–6.  https://doi.org/10.1007/s11695-015-1824-2.CrossRefPubMedGoogle Scholar
  44. 44.
    Garofalo F, Denis R, Pescarus R, et al. Long-term outcome after laparoscopic sleeve gastrectomy in patients over 65 years old: a retrospective analysis. Surg Obes Relat Dis. 2017;13(1):1–6.CrossRefGoogle Scholar
  45. 45.
    Peguinot A, Prevot F, Dharih A, et al. Is Sleeve Gastrectomy still contraindicated for patients aged >60 years? A case-matched study with 24 months of follow-up. Surg Obes Relat Dis. 2015;11(5):1008–13.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Denis Pajecki
    • 1
    Email author
  • Andre Morrell
    • 1
  • Marco Aurelio Santo
    • 1
  1. 1.Bariatric and Metabolic Surgery Unit – Gastroenterology Department – Surgical DivisionHospital das Clínicas – University of São PauloSão PauloBrazil

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