Short and Mid term outcomes comparing morbidity and weight loss after Laparoscopic Sleeve Gastrectomy vs. Roux-En-Y Gastric Bypass in patients over 65 years of age and older.

Joel S Frieder, MD, Camila Ortiz Gomez, MD, Rene Aleman, MD, Maria C Fonseca, MD, David Romero Funes, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Background: Bariatric surgery in the elderly population has been reported as feasible and safe. Laparoscopic Sleeve Gastrectomy (LSG) seems to have fewer complications than Laparoscopic Roux-En-Y Gastric Bypass (RYGB), even in the over 65 age group. We analyzed the difference in weight loss between LSG and RYGB in patients ≥65 years of age.

Methods: After IRB approval we retrospectively reviewed 2,486 patients, who underwent either LSG or RYGB between 2005 and 2018 at our institution. Basic demographics, preoperative BMI and comorbidities were described. We identified all patients ≥65 years old and subsequently divided them in two groups depending on the type of bariatric procedure performed. Analysis and comparison of outcomes between these groups were done. Post-operative BMI was reviewed at 6, 12 and 24 months and %EBMIL was calculated accordingly. T-test and Chi² analysis were performed for nominal and categorical variables, respectively.

Results: From 2,486 patients reviewed, 22.73%(n=565) were ≥65 years old. From these, 43.19%(n=244) underwent LSG and 56.81%(n=321) RYGB (Table 1). Caucasians and females were predominant in both groups. Mean age was similar for both populations (LSG:71.10±3.96, RYGB:71.67±4.54). Pre-procedure mean BMI was similar in both groups (40.46±5.48 for LSG vs. 43.68±7.22 for RYGB). Postoperative follow-up rates were similar in both groups at 12 and 24 months (LSG:51.23% and 31.56%; RYGB:48.29% and 34.27%; p=0.4883 and p=0.4976). The %EBMIL at 6, 12 and 24 months was higher for the RYGB group vs. the LSG group (59.27±27.91, 72.10±29.51, 77.35±26.11 vs. 50.16±21.85, 55.21±25.58, 43.85±32.23; p=0.0006, p<0.0001 and p<0.0001; respectively). Complication rates were significantly higher in RYGB vs. LSG (27.73% vs 9.43%; p<0.0001). We observed significantly higher anastomotic ulcer and stricture rates for RYGB vs. LSG (7.17% and 5.92% vs. 0% and 0%; p<0.0001 and p=0.0015, respectively). RYGB had a higher rate for GI obstruction requiring intervention (2.18% vs. 0.41%; p=0.0776). A similar De Novo GERD rate was noted in both procedures (3.74% vs. 3.69%; p=0.9753). No leaks were reported in either group (Table 2).

Conclusions: Both LSG and RYGB are effective weight loss procedures for patients ≥65 years of age. RYGB seems to have higher %EBMIL at 1 and 2 years, however it has almost three times higher complication rate than LSG.