Introduction Laparoscopic Sleeve Gastrectomy (LSG) is an increasingly popular procedure for the management of obesity. Despite good evidence to support the efficacy of LSG, there is a paucity of data in relation to outcomes in the elderly. Here we present our initial experience.
Method Data from 38 patients aged 60 years or over, who underwent LSG within a single surgeon experience of 712 cases between 2007 and 2013 was analysed. A "long, tight' sleeve was performed over a 29Fr bougie. A prospectively maintained database included information on patient demographics, Body Mass Index (BMI), excess body weight loss (EBWL), complications and comorbidity resolution. Quality of life was assessed using the Impact of Weight on Quality of Life Questionnaire - Lite (IWQOL-Lite) tool.
Results 12 patients were male (31.6%) and 26 were female (68.4%). The mean age at the time of surgery was 64.1 +/- 1.0 years and the mean pre-operative BMI was 44.4 +/- 2.1 kg/m2 (range 34.9 – 60.7, 95% CI). Follow-up rates were 100% at 6 months, 93% at 12 months and 74% at 24 months. Mean EBWL at 6 months, 12 months and 24 months was 64%, 72% and 80%, respectively.
The prevalence of comorbidity in the cohort pre-operatively was: diabetes mellitus 57.9% (n = 22), obstructive sleep apnoea 36.8% (n = 14) and hypertension 65.8% (n = 25). Diabetes resolved in 31.8% of subjects and improved in 54.5%. Sleep apnoea resolved in 50% of patients and 28.6% reported an improvement. Hypertension resolved in 48% of our cohort, with an improvement evident in 24%.
At a mean of 21.2 months, all patients who had completed the IWQOL-Lite questionnaire reported an improvement in quality of life. A lower percentage score indicates a better quality of life. The mean IWQOL-Lite score was significantly lower following a "long, tight' LSG, 29.6% vs. 59.1% pre-operatively (p < 0.001).
There were no deaths or leaks within the elderly cohort. No patients required endoscopic dilatation post-operatively. One patient was re-operated on for hiatus hernia/reflux following LSG. The incidence of post-operative venous thromboembolism was higher in the elderly group following LSG, 5.3% (n = 2) vs. 0.5% (n = 3) in the 674 patients under the age of 60.
Conclusion Our data supports the 'long, tight' LSG as an option for the surgical management of obesity and metabolic disease in the elderly. It is safe and effective in terms of weight loss and comorbidity resolution within a population over 60 years of age. Furthermore, we have demonstrated an improvement in quality of life within this patient group.
Disclosure of interest None Declared.
Willkomm CM, Fisher TL, Barnes GS, Kennedy CI, Kuhn JA. Surgical weight loss >65 years old: is it worth the risk? Surg Obes Relat Dis. 2010;6(5):491-496
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