OBES SURG DOI 10.1007/s11695-015-1735-2

ORIGINAL CONTRIBUTIONS

Sleeve Gastrectomy in Different Age Groups: a Comparative Study of 5-Year Outcomes D. Keren 1,3 & I. Matter 2 & T. Rainis 1

# Springer Science+Business Media New York 2015

Abstract Background Laparoscopic sleeve gastrectomy (LSG) has been used more frequently over the past 10 years. As the population ages, a larger number of older people will suffer from weight-related comorbidities, resulting in bariatric surgery becoming a dominant solution for improving health and quality of life. We assessed the long-term outcomes of LSG in elderly patients. Methods We conducted a retrospective chart review of patients who underwent LSG between January 2007 and August 2009. We subdivided 123 patients into 55 (n=21) age groups. Results The respective mean excess body mass index loss and excess weight loss were 42.5 %±3.1 % and 41.3 %±12.3 % for the 55 age group. The follow-up compliance rates at the 5-year visit were 23.85, 31.11, and 47.61 % for the 55 age groups, respectively. The corresponding Bariatric Analysis and Reporting Outcome System scores were 3.7±1.1, 4.0±0.7, and 5.3±1.3. The comorbidities of all the patients improved significantly, with a non-significant distribution between the three groups for each comorbidity. * D. Keren [email protected] 1

Departments of Gastroenterology, Bnai-Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

2

General Surgery, Bnai-Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

3

Bariatric Gastroenterology Clinic: Gastroenterology Unit, Bnai-Zion Medical Center, 47 Golomb Ave, POB 4840, Haifa 31048, Israel

Conclusions LSG is a useful tool for people who want to modify their eating habits and lose weight healthily. This study suggests that long-term weight loss, improvements in comorbidity, and compliance to follow-up are significant for patients >55 years old. Keywords Sleeve gastrectomy . Long term results . Elderly . Bariatric surgery

Introduction The prevalence of overweight and obesity among the adults in Organisation for Economic Co-operation and Development countries exceeds 50 % [1]. Moreover, 18 % of the adult population is considered obese, and the obesity rate has increased by more than a third since the year 2000 [1]. The use of laparoscopic sleeve gastrectomy (LSG) has increased steadily over this period and is currently the most frequently used surgical option for morbid obesity. Data emerging from several studies now demonstrates that LSG results in substantial weight loss and resolution of comorbidities after several years of follow-up [2] [3]. It has also been shown to be suitable for high-risk patients, including the elderly [4]. As the population ages, older patients will account for increasing numbers of weight-related illnesses, and the bariatric solution might play an increasingly dominant role in improving the health and quality of life of this age group [5]. Studies show that the majority of the patients selected for operation were younger than 50 years, despite the fact that the prevalence of obesity is higher in the older age groups [6]. However, although LSG is safe in the older population, its long-term outcomes with respect to weight loss, comorbidity resolution, and quality of life remain unclear [7] [8] [9].

OBES SURG

This study therefore aimed to assess the long-term 5-year outcomes of LSG in elderly patients, specifically by comparing the outcomes for young (55 years) age groups.

Methods We completed a retrospective chart review of all patients who underwent LSG between January 2007 and August 2009. The experimental protocol was approved by the Institutional Review Board of the Bnai-Zion Medical Center. All patients were required to meet the 1991 National Institutes of Health Consensus Conference guidelines for bariatric surgery, with a body mass index (BMI)≥40 kg/m2 or a BMI≥35 kg/m2 with associated comorbidities. The patients were subdivided into three age groups: group I, 55. Excess BMI loss (EBMIL) was used to compare the values before and after the operation. A BMI of 25 kg/m2 was the lowest limit of overweight [10]. %EBMIL was chosen being a relative parameter and allowing for objective comparisons among the series. According to the Reinhold criteria, used previously, we considered the surgery a failure if the patients achieved less than 50 % excess weight loss (EWL) [11] [12]. Quality of life (QOL) was measured with updated Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires, which were completed by all the patients during the 5year postoperative assessment. It included an analysis of weight loss, improvements in obesity-related comorbidities, and QOL changes. Final scores considered bariatric surgery outcomes a failure if ≤1, fair if >1 to 3, good if >3 to 5, very good if >5 to 7, and excellent if >7 to 9 [13].

Statistical Methods Data are presented as mean (SD) or number (%) as appropriate and unless otherwise stated. Then, chi-square (χ2) test was used to analyze categorical data and compare weight loss among the participants in the three groups. Analysis of variance was used to compare the mean anthropometric values among the three groups. Multiple regression techniques were used to analyze the influence of age and initial BMI on EWL, with level of significance at 95 %. The significance threshold was set at p=0.05.

Results Of the 130 patients who underwent LSG as their first bariatric procedure during the study period, 123 were included in our analysis (women=89 patients, 72.35 %). We excluded seven patients from the study because they underwent biliopancreatic diversion due to insufficient weight loss.

Average age was 42.3 years (range, 18–67 years), the mean preoperative weight was 119.2 kg (range, 92.3–172.4 kg), and the average BMI was 44.3 kg/m2 (range 35–52.3 kg/m2). The patients were divided into three predefined age groups: age, 55 (n=21). The respective mean weights and BMIs for the three groups were 121.3±4.8 kg and 42.1±3.9 kg/m2 for the young group, 118.6 ±5.4 kg and 44.2±3.8 kg/m2 for the middle age group, and 110.7±3.2 kg and 38.32±4.1 kg/m2 for the old age group. The descriptive data are summarized in Table 1.

Weight Loss At the 5-year follow-up, the mean %EBMIL was 49.1 %± 19.6 % and the %EWL was 45.3 %±19.5 %. The changes in body weight status are shown in Table 2. Respective means for %EBMIL and %EWL were 42.5 %±3.1 % and 41.3 %± 12.3 % in the young group, 48.7 %±4.1 % and 45.6 %± 10.6 % in the middle-aged group, and 53.6 %±4.6 % and 52.1 % ± 11.1 % in the old group (P < 0.01). At 5 years (Table 3), the overall success rate (patients with %EWL>50) was 23.26 % in the young group, 27.12 % in the middle-aged group, and 52.38 % in the older age group (P

Sleeve Gastrectomy in Different Age Groups: a Comparative Study of 5-Year Outcomes.

Laparoscopic sleeve gastrectomy (LSG) has been used more frequently over the past 10 years. As the population ages, a larger number of older people wi...
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