Bariatric Surgery in Elderly Patients

Yıl 2021, Cilt: 11 Sayı: 1, 23 - 26, 01.04.2021

Fatih Çiftçi Turgut Anuk

Öz

Aim: Although bariatric surgery for elderly obese patients is having high complication risks and with indefinite results, can be still beneficifial. The aim of this study is to evaluate the results of sleeve gastrectomy in elderly patients.
Materials and methods: All 65 years or older patients underwent laparascopic sleeve gastrectomy operation between April 2013-September 2017 included in this retrospective study. Demographic data, comorbidities due to obesity, body mass index, pre and post operative weight, recovery from comorbidities, follow-up time, post –operative complications, and duration of hospital stay were recorded. Elderly patients and patients under 65 years underwent sleeve gastrectomy were comparised according to results.
Results: Fourteen patients ( mean age 66.9+- 1.9 years) operated on for laparascopic sleeve gastrectomy. Mean 52,9% BMI loss obtained in the patients after 19 months follow-up. In the elderly patients significant improvements were obtained for the comorbidities due to obesity. Complication rates were similiar among the two groups.
Conclusion: Laparascopic sleeve gastrectomy is an effecitive and safe operation in elderly obese patients, but weight loss is more tolerable compared to younger patients. A selective group of elderly patients may benefit from bariatric surgery.

Anahtar Kelimeler

The surgery of obesity, sleeve gastrectomy, elderly patients, bariatric surgery, obesity

Yaşlılarda Obezite Cerrahisi

Öz

Amaç: Bariatrik cerrahi ileri yaş obez hastalar için riskli ve uzun dönem sonuçları müphem olsa da, fayda görmektedirler. Bu çalışmamız da ileri yaştaki hastalarımız da sleeve gastrektomi sonuçlarını değerlendirmeyi amaçladık.
Materyal ve Metot: Bu retrospektif çalışmada Nisan 2013-Eylül 2017 tarihleri arasında Laparoskopik sleeve gastrektomi geçirmiş 65 yaş ve üstü tüm hastaları çalışmaya dahil ettik. Hastaların demografik verileri, obezite ile ilgili komorbidite, beden kitle indeksi(BKİ), ameliyat öncesi ve sonrasında kilo durumları, komorbiditenin iyileşmesi, takip süresi, ameliyat sonrası komplikasyonlar ve hastanede kalış süresi kaydedildi. İleri yaştaki hastaları 65 yaş altı sleeve gastrektomi hastalarıyla karşılaştırdık.
Bulgular: Ondört hastaya (ortlama yaş 66.9±1.9 yıl) laparoskopik sleeve gastrektomi uygulandı. Hastalar 19 aylık takipten sonra ortalama %52.9 BKİ kaybına ulaştı. Yaşlı hastalar obeziteye bağlı tüm komorbiditelerde belirgin iyileşme gösterdi.Komplikasyon oranları iki grup arasında benzerdi.
Sonuç: Yaşlı obezler de laparoskopik sleeve gasterktomi güvenli ve etkilidir ancak kilo kaybı genç obez kişilere göre nisbeten daha azdır. Uygun seçilmiş yaşlı hastalar bariatrik cerrahiden yararlanabilir.

Anahtar Kelimeler

Obezite Cerrahisi, Tüp Mide, Yaşli Hastalar, Bariatrik Cerrahi, Obezite

Kaynakça

• 1- Pechman DM, Muñoz Flores F, Kinkhabwala CM, Salas R, Berk RH, Weithorn D, et al. Bariatric surgery in the elderly: outcomes analysis of patients over 70 using the ACS-NSQIP database. Surg Obes Relat Dis. 2019;15(11):1923-1932.
• 2- Nevo N, Eldar SM, Lessing Y, Sabo E, Nachmany I, Hazzan D. Sleeve Gastrectomy in the Elderly. Obes Facts. 2019;12(5):502-508.
• 3- Nickel F, de la Garza JR, Werthmann FS, Benner L, Tapking C, Karadza E,et al. Predictors of Risk and Success of Obesity Surgery. Obes Facts. 2019;12(4):427-439.
• 4- Dietrich A, Aberle J, Wirth A, Müller-Stich B, Schütz T, Tigges H. Obesity Surgery and the Treatment of Metabolic Diseases. Dtsch Arztebl Int. 2018;115(42):705-711.
• 5- Cho EJ, Kim SM. Revisional surgery after removal of eroded adjustable gastric bands. Asian J Surg. 2019;42(6):688-695.
• 6- Viscido G, Gorodner V, Signorini FJ, Biasoni AC, Navarro L, Rubin G,et al. Obese Patients with Type 2 Diabetes: Outcomes After Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A. 2019 ;29(5):655-662.
• 7- Almerie MQ, Rao VSR, Peter MB, Sedman P, Jain P. The Impact of Laparoscopic Gastric Bypass on Comorbidities and Quality of Life in the Older Obese Patients (Age > 60): Our UK Experience. Obes Surg. 2018;28(12):3890-3894.
• 8- Minhem MA, Safadi BY, Habib RH, Raad EPB, Alami RS. Increased adverse outcomes after laparoscopic sleeve gastrectomy in older super-obese patients: analysis of American College of Surgeons National Surgical Quality Improvement Program Database. Surg Obes Relat Dis. 2018;14(10):1463-1470.
• 9-Pontiroli AE, Ceriani V, Sarro G, Micheletto G, Giovanelli A, Zakaria AS, Fanchini M, Osio C, Nosari I, Veronelli AM, Folli F; LAGB10 working group. Incidence of Diabetes Mellitus, Cardiovascular Diseases, and Cancer in Patients Undergoing Malabsorptive Surgery (Biliopancreatic Diversion and Biliointestinal Bypass) vs Medical Treatment. Obes Surg. 2019;29(3):935-942.
• 10- Golubic R, Laur C, Kelsey M, Livesy A, Hoensch J, Park A, et al. The Cambridge Intensive Weight Management Programme Appears to Promote Weight Loss and Reduce the Need for Bariatric Surgery in Obese Adults. Front Nutr. 2018;12;5:54.
• 11- Susmallian S, Barnea R, Weiss Y, Raziel A. Outcome of bariatric surgery in older patients. Surg Obes Relat Dis. 2018;14(11):1705-1713.
• 12- Uno K, Seki Y, Kasama K, Wakamatsu K, Umezawa A, Yanaga K,eta. A Comparison of the Bariatric Procedures that Are Performed in the Treatment of Super Morbid Obesity. Obes Surg. 2017;27(10):2537-2545.
• 13- Coblijn UK, Lagarde SM, de Raaff CAL, van Wagensveld BA, Smets EMA. Patients' preferences for information in bariatric surgery. Surg Obes Relat Dis. 2018;14(5):665-673.
• 14- Kaplan U, Penner S, Farrokhyar F, Andruszkiewicz N, Breau R, Gmora S,et al. Bariatric Surgery in the Elderly Is Associated with Similar Surgical Risks and Significant Long-Term Health Benefits. Obes Surg. 2018;28(8):2165-2170.
• 15- Abdel-Rahim MM, Magdy MM, Mohamad AA. Comparative study between effect of sleeve gastrectomy and mini-gastric bypass on type 2 diabetes mellitus. Diabetes Metab Syndr. 2018;12(6):949-954.
• 16- Janik MR, Mustafa RR, Rogula TG, Alhaj Saleh A, Abbas M, Khaitan L. Safety of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in elderly patients - analysis of the MBSAQIP. Surg Obes Relat Dis. 2018;14(9):1276-1282.
• 17- Gray KD, Moore MD, Bellorin O, Abelson JS, Dakin G, Zarnegar R, Pomp A, Afaneh C. Increased Metabolic Benefit for Obese, Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy. Obes Surg. 2018;28(3):636-642.
• 18- Susmallian S, Barnea R, Weiss Y, Raziel A. Outcome of bariatric surgery in older patients. Surg Obes Relat Dis. 2018;14(11):1705-1713.
• 19- Musella M, Milone M, Maietta P, Bianco P, Coretti G, Pisapia A, et al. Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up. Int J Surg. 2014;12(2):S69-S72.
• 20- Leonetti F, Capoccia D, Coccia F, Casella G, Baglio G, Paradiso F,et al. Obesity, type 2 diabetes mellitus, and other comorbidities: a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment. Arch Surg. 2012;147(8):694-700.
• 21- Aslaner A, Öngen A, Koşar M, Çakır T, Mayir B, Doğan U,et al. Relation between weight loss and age after laparoscopic sleeve gastrectomy. Eur Rev Med Pharmacol Sci. 2015;19(8):1398-402.
• 22- Ramirez A, Roy M, Hidalgo JE, Szomstein S, Rosenthal RJ. Outcomes of bariatric surgery in patients >70 years old. Surg Obes Relat Dis. 2012;8(4):458-62.
• 23- Yang X, Yang G, Wang W, Chen G, Yang H. A meta-analysis: to compare the clinical results between gastric bypass and sleeve gastrectomy for the obese patients. Obes Surg. 2013;23(7):1001-10.
• 24- Burchett MA, McKenna DT, Selzer DJ, Choi JH, Mattar SG. Laparoscopic sleeve gastrectomy is safe and effective in elderly patients: a comparative analysis. Obes Surg. 2015;25(2):222-8.
• 25-Guo X, Yin K, Chen DL, Chang XS, Zeng P, Zheng CZ. -Impacts of laparoscopic bariatric surgery on GLP-1 and Ghrelin level in patients with type 2 diabetes mellitus]. Zhonghua Wai Ke Za Zhi. 2013;51(4):323-7.
• 26- Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg. 2012;256(2):266-73.
• 27- Fischer L, Hildebrandt C, Bruckner T, Kenngott H, Linke GR, Gehrig T,et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22(5):721-31.
• 28- Eisenberg D, Bellatorre A, Bellatorre N. Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity. JSLS. 2013;17(1):63-7.
• 29- Cutolo PP, Nosso G, Vitolo G, Brancato V, Capaldo B, Angrisani L. Clinical efficacy of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass in obese type 2 diabetic patients: a retrospective comparison. Obes Surg. 2012;22(10):1535-9.
• 30- Luppi CR, Balagué C, Targarona EM, Mocanu S, Bollo J, Martínez C, et al. Laparoscopic sleeve gastrectomy in patients over 60 years: impact of age on weight loss and co-morbidity improvement. Surg Obes Relat Dis. 2015;11(2):296-301.