Essa M Aleassa, MD, Monique Hassan, MD, Kellen Hayes, MD, Voranaddha Vacharathit, Stacy Brethauer, MD, Philip R Schauer, MD, Ali Aminian, MD. Bariatric and Metabolic Center, DDI, Cleveland Clinic – Ohio
Introduction: The elderly are a special subset of the population due to their limited physiological reserve with aging. Revisional bariatric surgery is becoming more common with increase in primary bariatric procedures. Data on safety, weight loss, and metabolic effects of revisional bariatric surgery in elderly is limited. The aim of this study was to assess the safety and efficacy of revisional bariatric surgery in the elderly.
Methods: Clinical data of all elderly patients (65 years and above) who underwent elective revisional bariatric surgery at an academic institute between 2008 and 2014 were reviewed. Demographic data, perioperative variables, and postoperative outcomes were studied.
Results: A total of 52 patients were identified with a female predominance (3:1). Mean age was 68±2.8 years. Mean BMI at the time of revisional surgery was 39.3±10.3 kg/m2. The primary indication for revisional surgery included management of postoperative adverse events (n=32, 61.5%) and weight recidivism (n=20, 38.5%). In patients with postoperative complications, the most common indications for revisional surgery were dysphagia (n=8, 15.4%), marginal ulcer (n=7, 13.5%), gastric outlet obstruction (n=7, 13.5%), and fistula formation (n=5, 9.6%). The most common type of revisions included conversion of vertical banded gastroplasty to Roux-en-Y gastric bypass (RYGB, n=18), revision of RYGB (n=13), conversion of adjustable gastric banding to sleeve gastrectomy (SG, n=6), and SG to RYGB (n=4). Two out of seven (28.6%) patients with 30-day postoperative readmissions had serious complications that required reoperation. One of them underwent small bowel resection for ischemia and the other had thoracotomy for hemothorax evacuation developing secondary to a gastropleural fistula. While there was no mortality over the first 30 days postoperatively, two patients died 6 months after surgery due to infectious complications. In the median follow-up time of 20 (interquartile range, 10-38) months, mean weight and BMI changes of -15.8 kg and -5.6 kg/m2 were observed. Twenty-three (44.2%) patients had diabetes at time of revisional surgery. A mean reduction of 12.6 mg/dL in fasting blood glucose and 1.1% in glycated hemoglobin were noted between baseline and last follow-up.
Conclusion: Revisional bariatric surgery in elderly is associated with high complication rates. Our data indicate that revisional bariatric surgery can potentially alleviate symptoms and resolve complications of primary bariatric surgery. Elderly patients should have their risk stratified and weighed against the benefits of surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88174
Program Number: P578
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster