Obesity surgery safe and effective for seniors

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Gastric bypass conducted using laparoscopic techniques is just as safe and effective in patients over 65 years of age as it is in younger patients, according to study findings presented Thursday at the 26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS).

“This is the largest reported study of lap gastric bypass in patients over 65,” senior author Dr. Joseph A. Kuhn, from Baylor University Medical Center, Dallas, told Reuters Health. “This study shows excellent outcomes with laparoscopic gastric bypass utilizing standardized care paths, leading most patients to be discharged home on the day following surgery.”

Laparoscopic gastric bypass helps patients lose weight by altering the shape of the stomach, “bypassing” a portion of it to reduce the amount of food that can pass through to the small intestine. Because of this, the body does not absorb all the calories from all of the food that is eaten. The procedure is less invasive that the traditional “open” surgery, requiring just a small incision. The time to recovery is also faster with laparoscopy than with open surgical procedure. 

The study featured all patients who underwent laparoscopic gastric bypass or gastric banding at the researchers’ center since January 2005 with at least 6 weeks of postoperative follow-up. Of the 1753 patients studied, 153 were over 65 years of age.

Older patients had a higher operative risk profile compared with their younger counterparts, the authors found. Sleep apnea (46 percent vs. 33 percent), diabetes mellitus (62 percent vs. 31 percent), and hypertension (83 percent vs. 57 percent) were all more common in the older group.

Nonetheless, older patients had similar operating times (70 vs. 65 minutes), lengths of stay (1.6 vs. 1.3 days), and 30-day readmission rates (5.2 percent vs. 7.0 percent) as their younger counterparts.

Rates of postoperative complications—e.g., pulmonary, wound, and cardiac—did not exceed 1.9 percent in older patients and were, once again, on par with those seen in younger patients. No patients died.

At 12 months, older patients who underwent gastric bypass lost a similar amount of excess body weight as their younger peers: 60.4 percent vs. 71.9 percent. The corresponding values for gastric banding patients were 29.9 percent and 35.8 percent.

“When one considers the low threshold for the typical 70-year-old patient who might undergo hip, cardiac, or major (cancer) surgery, it seems quite reasonable to consider a similar low threshold for considering gastric bypass in the 70-year-old with diabetes, sleep apnea, severe reflux, (High cholesterol), hypertension and coronary artery disease,” Kuhn said.

“If one considers the enormous value of a rapid reversal of all of the above diseases following a 1-hour laparoscopic surgery, it seems even more appropriate to encourage laparoscopic gastric bypass in the older population of patients.”

By Anthony J. Brown, MD
NEW YORK (Reuters Health)

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