Safety and Efficacy of Gastric Bypass versus Sleeve Gastrectomy in Patients 65 and older

Lisandro Montorfano, MD, Federico Perez Quirante, MD, Alex Ordonez, MD, Nisha Dhanabalsamy, MD, Rammohan Rajmohan, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Introduction: The aim of our study was to compare the safety and efficacy of  Laparoscopic  Roux–en­Y  gastric  bypass  (LRYGB)  and  Sleeve  Gastrectomy  (LSG)  in patients aged ≥ 65 years. 

Material and Methods: A retrospective review of a prospectively collected database was performed. All the patients with ages ≥ 65who underwent LRYGB or LSG between 2010 and 2014 were analyzed. Demographics, preoperative body mass index (BMI), postoperative complications, postoperative BMI and readmissions were recorded and compared between procedures.

Results: A total of 115 patients were identified. Of these patients, seventy five (65.2%) underwent LSG and forty (34.7%) underwent LRYGB. The mean age of the LSG group was 68 years old (range 66–72) and the mean age of the LRYGB group was 67 years old (range 66–69) (p=0.025) In the LSG group 38 were women (51%) and 37 were men (49%). In the LRYGB group 25 were women (62%) and 15 were men (38%).  The mean preoperative weight and body mass index (BMI) was 116 kg (range 104–127 Kg) and 40 kg/m2 (range 38–45) for the LSG group and 119 kg (range 103–130 Kg.) and 41 kg/m2 (range 37–46) for the LRYGB group. When comparing both groups we did not find a significant difference regarding preoperative weight (p=0.71) and preoperative BMI (p=0.76).
The overall incidence of postoperative complications was 32.5% (13 patients) for the RYGB group and 9.3% (7 patients) for the LSG group. The incidence of postoperative new marginal ulcers (p<0.001) and de novo regurgitation (p=0.031) was higher for the LRYGB group (Table 1).
Regarding readmissions, 4 patients (10%) that underwent LRYGB and 7 patients (9%) that underwent LSG were readmitted at least one time. (p=0.91) 
The trend of postoperative BMI loss was similar for both procedures and no significant difference was found. (Table 2)

Conclusion: According to our data both procedures have a similar efficacy and the same rate of readmissions. On the other hand, our study showed that LRYGB has more complications than LSG in the elderly. We conclude that Sleeve Gastrectomy might be a safer choice in patient’s ≥ 65 years.

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