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Morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) occur at acceptable rates, but its safety and efficacy in the elderly are unknown.
A retrospective review was performed of all patients aged >60 years who underwent LSG from 2008 to 2012. These patients were 1:2 matched, by gender and body mass index (BMI) to young patients, 18...
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Similar publications
Sleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature.
Here, we report a case of a hiatal hernia 2 years after SG. In the case reported...
Introduction:
Laparoscopic sleeve gastrectomy (LSG) has shown excellent results in terms of weight loss and resolution of comorbidities. Despite that, the effect of LSG on gastroesophageal reflux disease (GERD) is still a controversial topic. Our objective was to evaluate the presence of gastroesophageal reflux symptoms, erosive esophagitis (EE),...
Citations
... %EWL following SG in youngers than 60 years compared to elderly [8,[39][40][41][42][43][44][45][46][47][48] MD of %EWL following SG showed that youngers experience an extra 7.06%EWL compared to elderly people following SG (MD: 7.06, CI 95%: 2.56-11.56) (Fig. 16). ...
Background
Today, bariatric surgeons face the challenge of treating older adults with class III obesity. The indications and outcomes of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) also constitute a controversy.
Methods
PubMed, Web of Science and Scopus were searched to retrieve systematic reviews/meta-analyses published by March 1, 2022. The selected articles were qualitatively evaluated using A Measurement Tool to Assess systematic Reviews (AMSTAR).
Results
An umbrella review included six meta-analyses retrieved from the literature. The risk of early- and late-emerging complications decreased by 55% and 41% in the patients underwent SG than in those receiving RYGB, respectively. The chance of the remission of hypertension and obstructive sleep apnea, respectively increased by 43% and 6%, but type-2 diabetes mellitus (T2DM) decreased by 4% in the patients underwent RYGB than in those receiving SG. RYGB also increased excess weight loss (EWL) by 15.23% in the patients underwent RYGB than in those receiving SG.
Conclusion
Lower levels of mortality and early- and late-emerging complications were observed in the older adults undergoing SG than in those receiving RYGB, which was, however, more efficient in term of weight loss outcomes and recurrence of obesity-related diseases
... While investigations have shown that LSG has similar effects on weight loss and the improvement of comorbidities as LRYGB, which has been the most frequently used bariatric surgery method in the past, the frequency of its application has significantly increased despite the fact that the long-term results are not yet sufficient. [7,8] LRYGB is both restrictive and malabsorptive procedure, whereas LSG is a restrictive surgical procedure. It has been demonstrated that both surgical techniques have positive effects on weight loss and weightrelated comorbidities. ...
... This is more common in super obese individuals with a preoperative Body -mass index of more than 50 kg/m 2 and 3 to 5 years after the major surgery. 4 Comparing SG to other less invasive and more severe bariatric procedures, it is an uncomplicated surgical technique that is associated with a low complication rate and very mild long-term nutritional insufficiency. 5 Stapled-line leakage, strictures, and stapleline leaks are the most significant side effects of this procedure. ...
... According to numerous researches, such as Mizrahi et al. 4 , the elderly group had a longer operating time, and the operating time increment in their report was significantly longer compared to the other findings; Luppi et al. 9 , Leivonen et al. 14 , and Pequignot et al. 15 . Mizrahi et al. 4 observed a greater rate of hiatal hernia, which was identified during surgical operations, with no statistically significant difference in terms of adhesion. ...
... According to numerous researches, such as Mizrahi et al. 4 , the elderly group had a longer operating time, and the operating time increment in their report was significantly longer compared to the other findings; Luppi et al. 9 , Leivonen et al. 14 , and Pequignot et al. 15 . Mizrahi et al. 4 observed a greater rate of hiatal hernia, which was identified during surgical operations, with no statistically significant difference in terms of adhesion. ...
... For instance, in a study comparing the patients over 60 years with those under 50 years for up to 22 months after LSG showed better results in the younger age group for BMI% change. 20 In a study conducted in our country, it is stated that age may be the determining factor for weight loss after LSG and that weight loss is less in patients over the age of 40 years. 21 Many studies have shown that the mean excess of weight loss was lower for the older patients and those younger than 45 years tended to have greater %BMI loss and %EBMIL than the older patients. ...
Background: Bariatric surgery has come out as an effective treatment for morbid obesity due to its effects as stabilized weight loss and remission of obesity related comorbidities like type 2 diabetes. Postoperative weight loss is affected by many factors and predictors of weight loss after bariatric surgery are controversial.This study has been performed to evaluate the impact of gender and age on the short-term outcomes of laparoscopic sleeve gastrectomy (LSG) in type 2 diabetic(T2D) obese patients.
Material and Methods: In this retrospective study, the records of morbidly obese patients with a body mass index(BMI)≥40 kg/m2, aged between 18-65 years old who underwent LSG and were followed-up for at least 6 months postoperatively were reviewed.Patients were subdivided into two groups according to age(≥50 y
... Ultimately, 11 studies with SG and 9 studies with RYGB were selected for data extraction with a combined total of 26,118 patients with SG (2397 patients over 60 years old and 23,721 aged 60 and under) and a total of 6638 patients with RYGB respectively (6106 patients over 60 years old and 532 aged 60 and under). Eleven of the included studies were case-matched, 6 with LSG [18,23,27,29,31,35] and 5 with LRYGB [15,18,21,22,36]. ...
... Of these studies, 71 were excluded because of the type of studies, design of the trial, and absence of the main primary outcome. Finally, 17 studies were included [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Fig. 2), which were published as full-length articles. In three studies [17,23,24], data were available for both LSG and LRYGB. ...
To evaluate, mid-term outcomes between elderly patients (EP, i.e., age > 60 years old) and young patients (YP, i.e., age < = 60 years old) who underwent laparoscopic bariatric surgery. Studies comparing EP versus YP for bariatric surgery published until April 2020 were selected and submitted to a systematic review and meta-analysis. After LSG, overall morbidity and specific post-operative complication rates (i.e., leak, abscess, hemorrhage, and reoperation) were significantly more frequent in EP compared with those in YP. Surgical outcomes were similar between EP and YP after LRYGB. Both procedures achieved weight loss, but it was statistically greater in YP compared with that in EP. In summary, this meta-analysis suggests that laparoscopic bariatric surgery is a safe and effective treatment in EP compared with that in YP.
... While this precludes a dedicated analysis of sleeve gastrectomy outcomes in our cohort, existing literature demonstrates similar benefits for sleeve gastrectomy in the elderly. Septuagenarians undergoing laparoscopic sleeve gastrectomy, instead of RYGB, are therefore also likely to experience similar, favorable outcomes concerning safety and early to mid-term results [27][28][29][30]. Even though our findings highlight the health benefits of RYGB in the elderly, the implications of this study on long-term life expectancy in the elderly after gastric bypass are inconclusive. ...
PurposeUpper age limits for bariatric surgery are questioned on the merits of increased complication rates in the elderly and questionable efficacy. This study evaluates outcomes of bariatric surgery in patients ≥ 70 years of age.Materials and Methods
Retrospective review was performed of patients ≥ 70 years of age who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) between 2001 and 2018. Primary endpoints were 30-day readmission, Clavien-Dindo grade III–V (CD III–IV) complications, and mortality. Secondary data included were weight loss, long-term outcomes, comorbidity resolution, hemoglobin A1C, and lipid panels.ResultsA total of 23 patients with an average age of 72 years (range 70–80 years) and mean BMI of 43.3 (range 37.3–56.0) were reviewed. Average length-of-stay was 2.4 days (range 1–6 days), with the only acute complication being aspiration pneumonia in one patient. Median follow-up was 69.3 weeks (range 9–875 weeks). One-year follow-up rate was 96%, during which no deaths or CD III-IV complications occurred. Subsequently, one patient experienced failure-to-thrive requiring temporary enteral nutrition. Average 1 year percent total weight loss (%TWL) was 29%, and this was maintained on subsequent follow-ups. Average 1 year percent excess weight loss (%EWL) was 60%, maintained long-term at 61%. Significant serum biochemical improvements included hemoglobin A1C (6.9 ± 1.4% to 5.6 ± 1.3%, p = 0.001), triglycerides (155 ± 49 mg/dL to 102 ± 41 mg/dL, p = 0.0003), and high-density lipoprotein cholesterol (48 ± 14 mg/dL to 58 ± 22 mg/dL, p = 0.004).Conclusion
Laparoscopic RYGB is a safe and effective treatment for obesity and obesity-related comorbidities in septuagenarians.
... We detected an acceptable amount of %EWL, remission or improvement of several obesityrelated comorbidities, with comparable rates of complications, consistently with the other previous studies. 13,[20][21][22][23][24][25][26][27][28][29][30] Although a greater %EWL during the follow-up was detected in younger patients after LSG, the difference in comorbidity resolution was significant only for OSA. ...
Background and Aims:
Laparoscopic sleeve gastrectomy (LSG) among older obese subjects (>60 years of age) has recently gained popularity because of the population aging. We performed a meta-analysis to clarify whether elderly patients undergoing this procedure have an increased complications risk.
Methods:
A literature search aiming at outcomes of LSG in elderly patients throughout Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases was performed from inception until June 2019. Primary endpoints consisted of mortality and overall complications. Secondary endpoints comprised excess weight loss percentage (%EWL), remission, or postoperative improvement of several comorbidities (type-2 diabetes [T2DM], hypertension, dyslipidemia, and obstructive sleep apnea [OSA]). Heterogeneity between the studies was assessed by I2 test and random effects model for the comparative analysis. Mean difference (MD) and relative risk (RR) were used to report the results.
Results:
Eleven studies involving 2259 patients were scrutinized for this study. Overall complications rates did not significantly differ among younger and elderly patients undergoing LSG (RR: 1.71; 95% CI [confidence interval]: 0.76-3.83; P = .19). %EWL was superior among younger patients (MD: -7.63; 95% CI: -13.19 - 2.08; P = .007) while there were no significant differences in remission of T2DM, hypertension, and hyperlipidemia between the age groups (RR: 1.04; 95% CI: 0.83-1.31; P = .72; RR: 1.00; 95% CI: 0.84-1.18; P = .96; RR: 1.05; 95% CI: 0.79-1.38; P = .76). Younger patients exhibited a significantly higher OSA remission/improvement rate (RR: 0.81; 95% CI: 0.69-0.95; P = .001).
Conclusion:
LSG is a reliable bariatric method that is also safe in elderly patients with similar overall morbidity and similar obesity-related comorbidity resolution rates than younger ones, although weight loss outcomes were inferior.
... In the literature, there are reports indicating that surgery in elderly patients can be performed with good outcomes, without an increase in morbidity and mortality [4,[10][11][12][13][14][15]. Some authors even observed a lower rate of complications in these patients [16][17][18][19]. On the other hand, recently, Giordano et al. [4] published a meta-analysis that compared RYGB in patients older than 60 years, finding an increase in postoperative morbidity and less effectiveness in excess weight loss and resolution of comorbidities compared with younger patients, a phenomenon also observed in other publications, with other procedures [5,6,20,21]. ...
... When comparing the risk/benefit that bariatric surgery gives to the patient, all authors recognize its usefulness to a greater or lesser extent. Is important to acknowledge that elderly patients have more prevalence of comorbidities such as hypertension, dyslipidemia, and T2DM; this is in line with other publications [13,18,19,[23][24][25][26]. This characteristic may be a source of bias favoring complications in the aged group, so a matched case-control study might be the best way to address this matter. ...
Background
Obesity is a global health problem that also affects older adults. In Chile, as in most of the developing countries, more than half of older adults are overweight or obese, and bariatric surgery may be riskier for this group. The aim of this study is to compare our experience in patients over 60 years of age with a control group to determine associated surgical morbidity and mortality.
Methods
Case-control study of bariatric surgeries performed between 2006 and 2017 in our institution. Patients aged ≥ 60 years for the case group versus control group for patients ≤ 50 years selected randomly, matched by body mass index, type 2 diabetes, hypertension, dyslipidemia, surgical technique, and gender (ratio 1:2). Primary endpoint was surgical morbidity, 30-day readmission, and mortality.
Results
Seventy-two patients in case group were matched with 144 patients in control group. Surgical complications rate was the same for both groups. No differences were observed in the conversion to open surgery rate or 30-day readmission rate. There was no mortality in this series.
Conclusion
In this case-control study, being elderly does not increase the risk of morbidity and mortality associated with bariatric surgery.
... Goiten et al. showed in their study that only the presence of gastroesophageal reflux disease (GERD) was predictive of HH presence [4]. We have previously shown a higher prevalence of HH in patients older than 60 years [17]. Thus, some may advocate a more tailored pre-operative work-up only for elderly patients or those who present with GERD. ...
Background
Controversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH).
Methods
The institution’s prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and compared to the presence of an intraoperative HH.
Results
During the study period, a total of 1810 patients (854 males, 956 females) underwent LSG at our institution. Mean age was 40.95 ± 13 years (range 11–75), and mean BMI was 42.8 ± 5 kg/m² (range 30–86). The overall prevalence of HH was 11.1% (201 patients). All HHs detected were repaired. Considering the intraoperative identification of HH the gold standard for diagnosis, the sensitivity and specificity of preoperative UGI fluoroscopy for HH detection were 32% (66/201) and 94% (1512/1609), respectively. The median operative time was significantly longer when concomitant LSG and HH repair was performed compared to LSG alone (76 min vs. 55 min, p < 0.001, respectively). The foreknowledge of HH had no influence on the median operative times (77 min vs. 75 min, predicted vs. incidental, respectively, p = 1.34). HH repair did not affect the complication rate (p = 0.3).
Conclusion
Routine preoperative upper GI fluoroscopy holds a low sensitivity for HH detection. Health policy regulators should consider omitting this exam from routine preoperative evaluation for bariatric patients.
... Several previous studies have assessed the outcomes of bariatric surgery in patients older than 60 years [6][7][8][9][10][11]. These investigations have generally shown the procedures' safety in this age group, although occasionally with higher rates of perioperative complications when compared to their younger counterparts [6]. ...
... Several previous studies have assessed the outcomes of bariatric surgery in patients older than 60 years [6][7][8][9][10][11]. These investigations have generally shown the procedures' safety in this age group, although occasionally with higher rates of perioperative complications when compared to their younger counterparts [6]. Only a handful of studies have evaluated outcomes in patients older than 65, and even fewer in those older than 70 [4,[12][13][14][15][16]. ...
... Similar complication rates were reported between the groups (13.8 vs. 15%, p = 0.889, for the older and younger patients, respectively). Mizrahi et al. published a cohort of 52 morbidly obese patients ≥ 60 and compared them with a matched cohort of patients younger than 50 [6]. The rate of minor postoperative complications was higher in the older group (25 vs. 4.8%, p < 0.001), including atrial fibrillation (9.5%), urinary tract infection (7%), trocar-site hernias (4%), surgical-site infection, postoperative bleeding, bowel obstruction, dysphagia, nutritional deficiency, and colitis. ...
Background:
Few previous studies have assessed the safety of bariatric surgery in septuagenarians.
Methods:
A retrospective analysis of all patients 70 years or older who underwent laparoscopic sleeve gastrectomy at our institution between 2012 and 2017 was performed. This group was compared to a matched cohort of younger LSG patients (18-50 years) who were operated during the same time period.
Results:
Thirty septuagenarian LSG patients were compared to 60 younger patients. Gender distribution, preoperative weight, and preoperative body mass index (BMI) were comparable, although patients in the older age group suffered from more preoperative comorbidities (100 vs. 51.7%, p < 0.001). Operative time was longer (77.2 vs. 57.3 min, p = 0.005) and more hiatal hernias were repaired (46.7 vs. 8.3%, p < 0.001) in the older age group. Intraoperative complications occurred more in the older age group (6.7 vs. 0%, p = 0.04) but the overall complication rate (13.3 vs. 5.0%, p = 0.17) and the postoperative complication rate (10.0 vs. 5.0%, p = 0.38) were comparable. After a mean follow-up period of 31.3 and 33.5 months, the percentage of total body weight loss was 24.6 and 28.3% for the older and younger patients, respectively (p = 0.11). Rates of improvement/remission of comorbidities were comparable between the groups.
Conclusions:
In a carefully selected group of severely obese patients ≥ 70 years old, LSG may be safe, with acceptable postoperative complication rates, weight loss results, and improvement in comorbidities.
