Abstract
Introduction
In the elderly obese population, frequently suffering from multiple comorbidities, laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered a high-risk procedure. The aim of this study was to evaluate short-term safety (30-day hospital morbidity and mortality) of this procedure and its impact on weight and associated comorbidities in the medium term (type-two diabetes, hypertension, sleep apnea, hypercholesterolemia, and joint pain).
Methods
This study represents a retrospective analysis of all our Belgian patients older than 60 years of age who underwent a LRYGB between October 2004 and October 2012. Patient files were reviewed and patients were contacted by formal consultation or by phone for an update of their clinical status. Demographics, operative details, postoperative course, and the evolution of weight and associated comorbidities were registered.
Results
A total of 280 patients were included. A complete follow-up was available for 250 patients (89 %), of whom 161 were female and 89 male. Mean age, BMI, and hospital stay were 64.1 years (60–78 years), 41.9 kg/m2 (27.4–68 kg/m2), and 4.3 days (2–19 days), respectively. There was no in-hospital mortality, 27 (10.8 %) patients suffered from early postoperative complications and 5 (2 %) patients needed to be readmitted. After a mean follow-up of 31.5 months, the mean excess weight loss was 59.3 % (range 21.9–120.1 %). Resolution or improvement of diabetes, hypertension, sleep apnea, hypercholesterolemia, and joint pain was seen in 94.6, 77.6, 88.0, 77.1 and 57.6 % respectively.
Conclusion
LRYGB has an acceptable complication rate in the elderly. Since all obesity-related comorbidities improved during follow-up, there is a plea not to exclude this subgroup of patients from the well-known benefits of gastric bypass surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mathus-Vliegen EM, Obesity Management Task Force of the European Association for the Study of Obesity (2012) Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts 5(3):460–483. doi:10.1159/000341193.Epub
Flum D, Salem L, Elrod J, Dillenger P, Cheadle A, Chan L (2005) Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 294:1903–1908
Sugerman HJ, DeMaria EJ, Kellum JM, Sugerman EL, Meador JG, Wolfe LG (2004) Effects of bariatric surgery in older patients. Ann Surg 240:243–247
Livingston EH, Langert J (2006) The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg 141:1115–1121
Soto FC, Gari V, de La Garza JR, Szomstein S, Rosenthal RJ (2013) Sleeve gastrectomy in the elderly: a safe and effective procedure with minimal morbidity and mortality. Obes Surg 23(9):1445–1449
Oria HE, Moorehead MK (2009) Updated Bariatric Analysis and Reporting Outcome System (BAROS). Surg Obes Relat Dis 5(1):60–66
Dillemans B, Sakran N, Van Cauwenberge S, Sablon T, Defoort B, Van Dessel E, Akin F, Moreels N, Lambert S, Mulier J, Date R, Vandelanotte M, Feryn T, Proot L (2009) Standardization of the fully stapled laparoscopic Roux-en-Y gastric bypass for obesity reduces early immediate postoperative morbidity and mortality: a single center study on 2606 patients. Obes Surg 19(10):1355–1364
Deitel M, Greenstein RJ (2003) Recommendations for reporting weight loss. Obes Surg 13(2):159–160
Printen KJ, Mason EE (1977) Gastric bypass for morbid obesity in patients more than fifty years of age. Surg gynecol Obstet 144:192–194
Khan MA, Grinberg R, Johnson S, Afthinos JN, Gibbs KE (2013) Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important? Surg Endosc 27(5):1772–1777
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737
Ramirez A, Roy M, Hidalgo JE, Szomstein S, Rosenthal RJ (2012) Outcomes of bariatric surgery in patients >70 years old. Surg Obes Relat Dis 8(4):458–462
Nelson LG, Lopez PP, Haines K, Stefan B, Martin T, Gonzalez R, Byers P, Murr MM (2006) Outcomes of bariatric surgery in patients >65 years. Surg Obes Relat Dis 2(3):384–388
Contreras JE, Santander C, Court I, Bravo J (2013) Correlation between age and weight loss after bariatric surgery. Obes Surg 23(8):1286–1289
Sosa JL, Pombo H, Pallavicini H, Ruiz-Rodriguez M (2004) Laparoscopic gastric bypass beyond age 60. Obes Surg 14(10):1398–1401
Trieu HT, Gonzalvo JP, Szomstein S, Rosenthal R (2007) Safety and outcomes of laparoscopic gastric bypass surgery in patients 60 years of age and older. Surg Obes Relat Dis 3(3):383–386
Wittgrove AC, Martinez T (2009) Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities. Obes Surg 19(11):1472–1476
Willkomm CM, Fisher TL, Barnes SG, Kennedy IC, Kuhn JA (2010) Surgical weight loss >65 years old: is it worth the risk ? Surg Obes Relat Dis 6(5):491–497
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, LaMonte MJ, Stroup AM, Hunt SC (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357(8):753–761
Carlsson LM, Peltonen M, Ahlin S, Anveden Å, Bouchard C, Carlsson B, Jacobson P, Lönroth H, Maglio C, Näslund I, Pirazzi C, Romeo S, Sjöholm K, Sjöström E, Wedel H, Svensson PA, Sjöström L (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 367(8):695–704
Disclosures
Hanne Vanommeslaeghe, Bert Deylgat, Sebastiaan Van Cauwenberge, and Bruno Dillemans have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Grant Information
No grant support.
Rights and permissions
About this article
Cite this article
Vanommeslaeghe, H., Deylgat, B., Van Cauwenberge, S. et al. Laparoscopic Roux-en-Y gastric bypass in the elderly: feasibility, short-term safety, and impact on comorbidity and weight in 250 cases. Surg Endosc 29, 910–915 (2015). https://doi.org/10.1007/s00464-014-3751-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3751-z