Skip to main content
SpringerLink
Log in

Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes.

Objectives

The aim of this case-control study is to evaluate global results of LBS in patients ≥60 years (yr) with a matched case control study.

Methods

All patients ≥60 years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40–59 years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90 days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed.

Results

Fifty-five patients ≥60 year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40 year and patients 40–59 year (n = 55 each). Patients ≥60 year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P = 0.01), no difference in major complication rate was observed (P = 0.43). At 24 months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P = 0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60 year After a mean follow-up of 27 months, BAROS score (filled in by 82% of patients) was lower in patients ≥60 years (P = 0.01).

Conclusion

Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BAROS:

Bariatric analysis and reporting outcome system

BMI:

Body mass index

BS:

Bariatric surgery

GERD:

Gastroesophageal reflux disease

LBS:

Laparoscopic bariatric surgery

LOAGBP:

Laparoscopic one anastomosis gastric bypass

LSG:

Laparoscopic sleeve gastrectomy

MC:

Major complication

NAFLD:

Nonalcoholic fatty liver disease

%EWL:

Percentage of excess weight loss

QOL:

Quality of life

SD:

Standard deviation

T2D:

Type 2 diabetes

Yr:

Years

References

  1. Zamboni M, Mazzali G, Zoico E, et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes. 2005;29:1011–29.

    Article  CAS  Google Scholar 

  2. Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2013;35:51–65.

    Article  PubMed  Google Scholar 

  3. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370:2002–13.

    Article  PubMed  Google Scholar 

  4. Chow A, Switzer NJ, Gill RS, et al. 2015 Roux-en-y gastric bypass in the elderly: a systematic review. Obes. Surg. [Internet]. [cited 2016 Feb 19]; Available from: http://link.springer.com/10.1007/s11695-015-2007-x

  5. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627–35.

    PubMed  PubMed Central  Google Scholar 

  6. Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.

    PubMed  Google Scholar 

  7. Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004;240:243–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Flum DR, Salem L, Broeckel Elrod J, et al. Early mortality among medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.

    Article  CAS  PubMed  Google Scholar 

  9. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–63.

    Article  CAS  PubMed  Google Scholar 

  10. Heim N, Snijder MB, Heymans MW, et al. Optimal cutoff values for high-risk waist circumference in older adults based on related health outcomes. Am J Epidemiol. 2011;174:479–89.

    Article  PubMed  Google Scholar 

  11. Laville M, Romon M, Chavrier G, et al. Recommendations regarding obesity surgery. Obes Surg. 2005;15:1476–80.

    Article  CAS  PubMed  Google Scholar 

  12. Moorehead MK, Ardelt-Gattinger E, Lechner H, et al. The validation of the Moorehead-Ardelt quality of life questionnaire II. Obes Surg. 2003;13:684–92.

    Article  PubMed  Google Scholar 

  13. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  14. Dorman RB, Abraham AA, Al-Refaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP study. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment Tract. 2012;16:35–44. discussion 44

    Article  Google Scholar 

  15. 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. 2015;29:910–5.

    Article  PubMed  Google Scholar 

  16. Pequignot A, Prevot F, Dhahri 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 Off J Am Soc Bariatr Surg. 2015;11:1008–13.

    Article  Google Scholar 

  17. Abbas M, Cumella L, Zhang Y, et al. Outcomes of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in patients older than 60. Obes Surg. 2015;25:2251–6.

    Article  PubMed  Google Scholar 

  18. Montastier E, Becouarn G, Bérard E, et al. 2016 Gastric bypass in older patients: Complications, weight loss, and resolution of comorbidities at 2 years in a matched controlled study. Obes. Surg. [Internet]. [cited 2016 Feb 19]; Available from: http://link.springer.com/10.1007/s11695-015-2024-9

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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? Surg: Obes; 2015.

    Google Scholar 

  21. Spaniolas K, Trus TL, Adrales GL, et al. Early morbidity and mortality of laparoscopic sleeve gastrectomy and gastric bypass in the elderly: a NSQIP analysis. Surg. Obes. Relat. Dis. Off. J. Am. Soc. Bariatr Surg. 2014;10:584–8.

    Article  Google Scholar 

  22. Peraglie C. Laparoscopic mini-gastric bypass in patients age 60 and older. Surg Endosc. 2016;30:38–43.

    Article  PubMed  Google Scholar 

  23. Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8:487–99.

    Article  CAS  PubMed  Google Scholar 

  24. Navez J, Dardamanis D, Thissen J-P, et al. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: comparison of primary versus Revisional bypass by using the BAROS score. Obes Surg. 2015;25:812–7.

    Article  PubMed  Google Scholar 

  25. Jr IR, Coelho TH, Ravelli MN, et al. A comparative, prospective and randomized evaluation of Roux-en-Y gastric bypass with and without the silastic ring: a 2-year follow up preliminary report on weight loss and quality of life. Obes Surg. 2015;1–7

  26. Taylor CJ, Layani L. Laparoscopic adjustable gastric banding in patients ≥60 years old: is it worthwhile? Obes Surg. 2006;16:1579–83.

    Article  PubMed  Google Scholar 

  27. Fatima J, Houghton SG, Iqbal CW, et al. Bariatric surgery at the extremes of age. J Gastrointest Surg. 2006;10:1392–6.

    Article  CAS  PubMed  Google Scholar 

  28. Quebbemann B, Engstrom D, Siegfried T, et al. Bariatric surgery in patients older than 65 years is safe and effective. Surg. Obes. Relat. Dis. Off. J. Am. Soc. Bariatr. Surg. 2005;1:389–92. discussion 392–3

    Article  Google Scholar 

  29. Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2009;20:193–7.

    Article  PubMed  Google Scholar 

  30. Thibault R, Huber O, Azagury DE, et al. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35:12–7.

    Article  PubMed  Google Scholar 

Download references

Authors’ Contributions

Study concept and design: VB, DL, DB.

Acquisition of data: VB.

Analysis and interpretation of data: VB, DB, RT.

Drafting of the manuscript: DB, RT.

Critical revision of the manuscript for important intellectual content: DL, VB, AG.

Statistical analysis: VB.

Obtained funding: None.

Author information

Authors and Affiliations

  1. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France

    Damien Bergeat

  2. Université de Rennes 1, Rennes, France

    Damien Bergeat & Ronan Thibault

  3. UMR NuMeCan (Nutrition, Métabolismes, Cancer), INRA, ALICE, St Gilles, France

    Damien Bergeat & Ronan Thibault

  4. Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France

    David Lechaux, Adil Ghaina & Vianney Bouygues

  5. Unité de Nutrition, Service d’Endocrinologie-Diabétologie-Nutrition, INSERM U991, CHU Rennes, Université Rennes 1, F-35000, Rennes, France

    Ronan Thibault

Authors
  1. Damien Bergeat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Lechaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adil Ghaina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronan Thibault
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vianney Bouygues
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Damien Bergeat.

Ethics declarations

Funding

There was no financial support for this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Does not apply.

Electronic supplementary material

.

ESM 1

(DOCX 65 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bergeat, D., Lechaux, D., Ghaina, A. et al. Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study. OBES SURG 27, 1414–1422 (2017). https://doi.org/10.1007/s11695-016-2517-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2517-1

Keywords

Search

Navigation