Date Published: July 06, 2020
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Marcelo Protásio dos Santos, José Eduardo Gonçalves, André Akira Ramos Takahashi, Bruno Barros Britto, Fernando Bray Beraldo, Jaques Waisberg, Luciana Kase Tanno.
To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique.
Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant.
Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown. Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.
Obesity, given the significant associated morbidity and mortality rates, is considered a worldwide epidemic with high costs for society and health systems1. In 2014, the World Health Organization (WHO) estimated that approximately 1.9 billion adults worldwide were overweight and at least 600 million were obese2. The major medical concern regarding obesity is the large number of associated diseases, especially cardiovascular disease, diabetes, and malignant neoplasms3. Several long-term epidemiological studies have been able to demonstrate this strong association, as well as evidence of reduced quality of life and increased mortality in these patients4-6.
The research protocol for this study was approved by the Research Ethics Committee of the institution.
The average length of hospital stay was 5.67 ± 1.73 days (4 to 12 days). The average maximum weight was 116.6 kg ± 18.2 (93 kg to 180 kg) and the average weight after 24 months of follow-up was 73.1 kg ± 11.7 (50 kg to 100 kg). The mean %EWL was 74.6% ± 22.2 (31.8% to 135.6%) (Table 1).
The safety and efficacy of weight loss surgical procedures in the elderly is still controversial. Sugerman et al.19 evaluated 850 elderly patients undergoing RYGB and indicated an operative mortality rate of 0.6% and morbidity of 5.6%. The authors concluded that gastric bypass is a safe procedure in the elderly population due to low morbidity and mortality rates20. In the present study, there was no mortality, while the morbidity index was 29.6%. Yoon et al.21 compared the outcomes of RYGB and vertical gastrectomy among populations < 60 years and ≥ 60 years of age and found no significant differences between the two populations regarding unfavorable outcomes. Postoperative complication rates among the population < 60 years and ≥ 60 years were, respectively, 2.5% and 5%. Mean operative time was slightly longer in patients ≥ 60 years (210 minutes vs. 229 minutes) and readmissions at 30 days occurred more frequently in the ≥ 60 year-old group (2.5% vs. 12.5%). However, the reasons for hospital readmissions in any of the groups were not detailed in this study21. In the present series, no hospital readmissions were recorded within 30 days after the surgical procedure. We conclude that laparoscopic RYGB is an effective method for controlling T2DM, DLP, and OSAS in obese elderly individuals (≥ 60 years) in the first 24 months of postoperative follow-up. In addition, it has been shown to be a safe procedure with low rates of minor complications that often do not require surgical intervention in this population. However, further studies with a larger sample of people involved are needed to ratify the results obtained in the present series. Source: http://doi.org/10.1590/s0102-865020200060000006