Background: Current guidelines do not recommend bariatric surgery in the elderly. Given the disappointing results of medical therapy, elderly patients are seldom submitted to surgical treat- ment. This study evaluated the safety and efficacy of laparo- scopic adjustable gastric banding in older patients included in the database of Italian Group for Lap Band (GILB). Methods: GILB is a centralized database which collects the operative and follow-up data of 26 Italian surgical centres utiliz- ing the Lap-Band System® as adjustable gastric banding proce- dure. Patients ≥60 years old were selected from the database of the GILB and analyzed according to co-morbidities, conversion, peri-operative complications, and weight loss. Patients <60 years old were used as the control group. Results: 216 (184F/31M) out of 5290 (4.1%) patients were ≥60 years old at surgery (mean age 64.1±4.0 yrs; range 60-83). Baseline BMI was similar in patients ≥60 and <60 years old (44.2±7.6 vs 44.9±7.4 kg/m2). Patients ≥60 years old were more frequently affected by co-morbidities (hypertension, type 2 dia- betes, dyslipidemia, sleep apnea and osteoarthritis) than patients <60 years old. Two cases of operative mortality was observed in patients <60 years old (0.04%) and one in patients ≥60 years old (0.46%). The proportion of patients requiring revision surgery was similar in the two groups. %EWL was lower in patients ≥60 than in patients <60 years old: 26.9±18.8 vs 47.7±25.9% at 1 year (P<0.001); 28.3±18.6 vs. 52.6±26.8% at 2 year (P<0.001); 28.4±21.5 vs 52.2±27.1 at 3 year (P<0.001); 28.3±19.0 vs 58.1±27.9% at 5 years (P<0.001). Despite this lower weight loss, patients ≥60 years old experienced a significant improvement of obesity-related co-morbidities, with all patients suffering diabetes or sleep apnea and 67.1% of the patients with hypertension being disease free at one year after surgery. Osteoarthritis improved only in 34.9% of the patients. Conclusion: Laparoscopic adjustable gastric banding may be performed safely in patients ≥60 years old. Weight loss in older patients seems unsatisfactory if compared to younger subjects. However, the majority of them improved their co-morbidities. In the elderly, indication to perform gastric banding should be based more on the presence and type of co-morbidities than on obesity level.
Busetto, L., Angrisani, L., Favretti, F., Furbetta, F., Paganelli, M., Basso, N., et al. (2007). The use of laparoscopic adjustable gastric banding in the elderly. OBESITY SURGERY, 17, 121-121.
The use of laparoscopic adjustable gastric banding in the elderly
Bernante, P.;
2007
Abstract
Background: Current guidelines do not recommend bariatric surgery in the elderly. Given the disappointing results of medical therapy, elderly patients are seldom submitted to surgical treat- ment. This study evaluated the safety and efficacy of laparo- scopic adjustable gastric banding in older patients included in the database of Italian Group for Lap Band (GILB). Methods: GILB is a centralized database which collects the operative and follow-up data of 26 Italian surgical centres utiliz- ing the Lap-Band System® as adjustable gastric banding proce- dure. Patients ≥60 years old were selected from the database of the GILB and analyzed according to co-morbidities, conversion, peri-operative complications, and weight loss. Patients <60 years old were used as the control group. Results: 216 (184F/31M) out of 5290 (4.1%) patients were ≥60 years old at surgery (mean age 64.1±4.0 yrs; range 60-83). Baseline BMI was similar in patients ≥60 and <60 years old (44.2±7.6 vs 44.9±7.4 kg/m2). Patients ≥60 years old were more frequently affected by co-morbidities (hypertension, type 2 dia- betes, dyslipidemia, sleep apnea and osteoarthritis) than patients <60 years old. Two cases of operative mortality was observed in patients <60 years old (0.04%) and one in patients ≥60 years old (0.46%). The proportion of patients requiring revision surgery was similar in the two groups. %EWL was lower in patients ≥60 than in patients <60 years old: 26.9±18.8 vs 47.7±25.9% at 1 year (P<0.001); 28.3±18.6 vs. 52.6±26.8% at 2 year (P<0.001); 28.4±21.5 vs 52.2±27.1 at 3 year (P<0.001); 28.3±19.0 vs 58.1±27.9% at 5 years (P<0.001). Despite this lower weight loss, patients ≥60 years old experienced a significant improvement of obesity-related co-morbidities, with all patients suffering diabetes or sleep apnea and 67.1% of the patients with hypertension being disease free at one year after surgery. Osteoarthritis improved only in 34.9% of the patients. Conclusion: Laparoscopic adjustable gastric banding may be performed safely in patients ≥60 years old. Weight loss in older patients seems unsatisfactory if compared to younger subjects. However, the majority of them improved their co-morbidities. In the elderly, indication to perform gastric banding should be based more on the presence and type of co-morbidities than on obesity level.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
