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?

Abstract

Background: As life expectancy increases, more elderly patients fit into the criteria for bariatric procedures. The aim of our study is to evaluate and compare the safety and efficacy of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) in patients older than 60.

Material and methods: Between January 2005 and December 2013, 68 LAGB, 73 LSG, and 212 RYGB patients were 60 years or older at the time of primary procedure. A retrospective review was performed in these patients.

Results: Mean age and body mass index (BMI) was 62.7 ± 2.2, 64.1 ± 2.9, and 62.6 ± 2.3 years and 42.7 ± 5.6, 44.0 ± 7.0, and 45.2 ± 6.7 kg/m(2) for LAGB, LSG, and RYGB at the time of procedure, respectively. Seven (10.3%) patients from the LAGB, 3 (4.1%) from the LSG, and 29 (13.8%) from the RYGB group required readmissions. Reoperation rate was 10.3, 1.4, and 9.5% in LAGB, LSG, and RYGB, respectively. The difference in reoperation rates was statistically significant (p < 0.03) while that in readmission rates was not (p > 0.58). Procedure-related mortality rate was 1.4% in the RYGB group, while no mortality was observed in LSG and LAGB groups. At 6, 12, and 18 months postoperatively, mean percentage of excess weight loss were highest in the RYGB group, followed by LSG and LAGB group (p < 0.01). Mean number of comorbidities at the last follow-up significantly decreased in LSG and RYGB patients.

Conclusions: LSG showed the lowest readmission and reoperation rate, and RYGB patients had the highest mortality rate. Weight loss and comorbidity resolution were effectively achieved in RYGB and LSG patients.

Keywords: Age over 60; Complications; Efficacy; Elderly; Gastric banding; Gastric bypass; Morbidity; Mortality; Safety; Sleeve gastrectomy.