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Obesity Surgery

, Volume 19, Issue 11, pp 1472–1476 | Cite as

Laparoscopic Gastric Bypass in Patients 60 Years and Older: Early Postoperative Morbidity and Resolution of Comorbidities

  • Alan C. WittgroveEmail author
  • Tracy Martinez
Clinical Report

Abstract

Background

Bariatric surgery has not been routinely presented as an option for patients over 60 years of age. Part of the reason is the long-standing perception that there is additional risk. Additionally, until its recent ruling, Medicare was inconsistent in its coverage, thus making it difficult for some beneficiaries to gain access to the procedures. The aim of this study was to evaluate the perioperative morbidity in our patients who were 60 years of age or older who underwent a laparoscopic gastric bypass Roux-en-Y (LGBRY). We also report the impact of surgery on five objectively graded comorbidities in the early postoperative period.

Methods

Our prospectively maintained database was used to identify and report on all patients operated on at our program from January 2002 through January 2007.

Results

One hundred twenty patients were identified with 100% follow-up through the perioperative phase and 85% follow-up at 12 months. The mean age was 62 years (range 60–74) with a mean body mass index of 43 kg/m2 (range 34–70). All patients underwent an LGBRY. There was no 30-day mortality. Perioperative complications included: 13 strictures, one abscess, two wound infections, three ulcers, two small bowel obstructions, three bleeding episodes in patients who required coumadin, and atrial fibrillation in two patients. The five graded/measurable comorbid conditions (preop/postop) were diabetes mellitus type II (68/17), hypertension (86/10), obstructive sleep apnea requiring continuous positive airway pressure (CPAP; 48/3), hypercholesterolemia (106/18), and hypertriglyceridemia (60/5).

Conclusions

LGBRY can be done safely in patients over 60 years of age in an experienced bariatric program, even in patients with relatively high risk based on their comorbid conditions preoperatively. Resolution of associated comorbidities far exceeds that found with any other treatment modality.

Keywords

Gastric bypass Elderly Diabetes mellitus type 2 Sleep apnea syndrome Laparoscopic surgery 

References

  1. 1.
    Printen KJ, Mason EE. Gastric bypass for morbid obesity in patients more than fifty years of age. Surg Gynecol Obstet. 1977;144:192–4.PubMedGoogle Scholar
  2. 2.
    Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294(15):1903–8.CrossRefGoogle Scholar
  3. 3.
    Varela JE, Wilson SE, Nguyen NT, et al. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.PubMedGoogle Scholar
  4. 4.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 months follow-up. Obs Surg. 2000;10:64–7.CrossRefGoogle Scholar
  5. 5.
    Consensus Development Panel. Gastrointestinal surgery for severe obesity: NIH consensus development conference. Consensus statement 1991 March 25–27. Am J Clin Nutr. 1992;55(suppl):615s–9.Google Scholar
  6. 6.
    Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg. 2006;141(11):1115–20.CrossRefGoogle Scholar
  7. 7.
    Fatima J, Houghton SG, Iqbal CW, et al. Bariatric surgery at the extremes of age. J Gastrointest Surg. 2006;10(10):1392–6.CrossRefGoogle Scholar
  8. 8.
    Shawn D, St Pater MD, Randall O, et al. Impact of advanced age on weight loss and health benefits after laparoscopic gastric bypass. Arch Surg. 2005;140:165–8.CrossRefGoogle Scholar
  9. 9.
    Nelson LG, Lopez PP, Haines K, et al. Outcomes of bariatric surgery in patients >65 years. Surg for Obes Relat Dis. 2006;2:384–8.CrossRefGoogle Scholar
  10. 10.
    Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004;240(2):243–7.CrossRefGoogle Scholar
  11. 11.
    Dunkle-Blatter SE, St Jean MR, Whitehead C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis. 2007;3(2):163–9.CrossRefGoogle Scholar
  12. 12.
    McFarlane SI, Jacober SJ, Winer N, et al. Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers. Diabetic Care. 2002;25(4):718–23.CrossRefGoogle Scholar
  13. 13.
    Grant RW, Buse JB, Meigs JB, et al. Quality of diabetic care in U.S. academic medical centers: low rates of medical regimen changes. Diabetic Care. 2002;28:337–442.CrossRefGoogle Scholar
  14. 14.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–52.CrossRefGoogle Scholar
  15. 15.
    Benotti PN, Wood GC, Rodriguez H, et al. Perioperative outcomes and risk factors in gastric surgery for morbid obesity: a 9 year experience. Surgery. 2006;139:340–6.CrossRefGoogle Scholar
  16. 16.
    Quebbemann B, Engstrom D, Siegfried T, et al. Bariatric surgery in patients older than 65 years is safe and effective. Surg Obes Related Dis. 2005;1:389–93.CrossRefGoogle Scholar
  17. 17.
    Schwartz RD, Karpeh MS, Brennan MF, et al. Factors predicting hospitalization after operative treatment for gastric carcinoma in patients older than 70 years. J Am Coll Surg. 1997;184:9–15.Google Scholar
  18. 18.
    Bosshardt TL. Outcomes of ostomy procedures in patients aged 70 years and older. Arch Surg. 2003;138(10):1077–82.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  1. 1.Bariatric Program, Wittgrove Bariatric CenterScripps Memorial HospitalLa JollaUSA

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