Iswanto Sucandy, MD, Gintaras Antanavicius, MD FACS. Abington Memorial Hospital, Abington, Pennsylvania
Introduction : Although many risk factors affecting outcomes of bariatric procedures have been identified, the effect of age on weight loss and perioperative complications was not adequately investigated. Previous studies have reported that increasing age and preoperative BMI are independently associated with an increased risk of complications. Therefore, many surgeons are hesitant to offer bariatric surgery to older patients with significantly higher BMI because of considerably greater medical comorbidities, and less weight-control efficacy. In this study, we compare the weight loss outcome and perioperative complications following biliopancreatic diversion in high-BMI morbidly obese population stratified by age.
Methods : Review of a prospectively maintained database was conducted in all patients who underwent robotically assisted laparoscopic biliopancreatic diversion with duodenal switch (R-LBPD/DS) between December 2008 and July 2011. Data assessed included age, gender, preoperative and postoperative weight at 1-,3-,6-,9-,12-,18-month intervals, operative time, conversion rate, perioperative complications, length of stay (LOS), and readmission rates. Variables were compared based on the patients age (age 20-35, n=26 (group A), age 36-50, n=45 (group B), and age 51-72, n=36 (group C)). Statistical analysis was conducted using T-test and analysis of variance (Anova).
Results : A total of 107 consecutive patients (F:M=83:24) were included in this study, with no significant differences in gender distribution (p=0.39), preoperative weight (p=0.52), and body mass index (BMI) (p=0.84) among groups. The oldest group (C) had a statistically significant higher number of preoperative comorbidities (7.3) compared with those in groups A (5.4) and B (6.3) (p=0.0034). No statistically significant difference was found in the mean operative time (A=274, B=266, C=294minutes, p=0.074), or length of stay (A=3.0, B=2.7, C=3.3 days, p=0.16). All cases were successfully completed using minimally invasive approach. There were no intraoperative or 30-day major postoperative complications (ie; anastomotic leak, hemorrhage, intestinal obstruction, inadvertent intraabdominal organ injury, and thromboembolic event). Three patients developed minor complications : one in group C developed incarcerated umbilical hernia requiring laparoscopic repair, one in group A developed postoperative carpal tunnel syndrome exacerbation and another in group C had to return to the operating room for port site infection. Percentage of excess body weight loss (EBWL) at 1,3,6,9,12, and 18 months are comparable among groups, although group B trended toward higher weight loss outcome at 18 months compared with that in groups A and C ( 88% versus 81 % and 80.3%, respectively, p=0.27). No mortality occurred in this series.
Conclusions : Despite a higher number of preoperative medical comorbidities that translated into a higher perioperative risk, older patients perform as well as their younger counterparts with respect to operative time, conversion rate, perioperative complications, length of stay, and weight loss outcome.
Session Number: Poster – Poster Presentations
Program Number: P437