Effectiveness and Safety of Roux-en-Y Gastric Bypass in Elderly Patients—Systematic Review and Meta-analysis

Abstract

Introduction As the population ages, there is more interest in bariatric surgery for older patients. There are controversies regarding the safety and effectiveness of surgical weight loss in this population. Aim The aim of this study was to compare the safety and efficacy of Roux-en-Y gastric bypass in patients over the age of 60 years with younger patients. Methods The available literature was searched for eligible studies up to February 2018. Inclusion criteria were reports on mortality, morbidity, percentage excess weight loss (%EWL), remission of diabetes, remission of hypertension, and remission of obstructive sleep apnea. Random effects meta-analyses were performed. Results The initial search yielded 2000 references. The final meta-analysis involved nine studies and revealed significant differences in mortality (odds ratio 4.38, 95% confidence interval [1.25, 15.31], p = 0.02), morbidity (OR 1.88, CI [1.07, 3.30], p = 0.03), %EWL (mean difference − 5.86, 95% CI [− 9.15, − 2.56], p < 0.001), and remission of comorbidities. Conclusion Higher mortality and morbidity were found in the group of older patients. The analysis suggested lower effectiveness of Roux-en-Y gastric bypass for weight loss and improvement in comorbidity in older patients when compared with younger patients.

Gut Hormones in Health and Obesity: The Upcoming Role of Short Chain Fatty Acids

“…The only treatment that drastically improves patients' weight management in a sustainable way is the Roux-en-Y gastric bypass (RYGB) surgery. However, this is a costly, invasive procedure with side effects, that may not always be effective for everyone, for example in elderly patients [27,28]. Furthermore, up to 20% of patients who undergo RYGB experience significant weight regain [29].…”

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery

“…In those over 65 years, Obesity Surgery (both LSG and RYGBP) seems to have a greater number of complications, especially RYGBP, and to be associated with a lower rate of resolution of comorbidities (Giordano S, Haywood C, Marczuk P, Level of Evidence 1++) [ 55 , 63 , 88 ]. RYGBP also seems to be associated with higher mortality (Giordano S, Marczuk P, Level of Evidence 1++) [ 55 , 88 ].…”

“…In those over 65 years, Obesity Surgery (both LSG and RYGBP) seems to have a greater number of complications, especially RYGBP, and to be associated with a lower rate of resolution of comorbidities (Giordano S, Haywood C, Marczuk P, Level of Evidence 1++) [ 55 , 63 , 88 ]. RYGBP also seems to be associated with higher mortality (Giordano S, Marczuk P, Level of Evidence 1++) [ 55 , 88 ]. Weight loss appears to be significantly less than in younger RYGBP patients (Giordano S, Marczuk P, Level of Evidence 1++) [ 55 , 88 ], although with LSG it seems that the loss is similar (Haywood C, Level of Evidence 1−) [ 63 ].…”

“…RYGBP also seems to be associated with higher mortality (Giordano S, Marczuk P, Level of Evidence 1++) [ 55 , 88 ]. Weight loss appears to be significantly less than in younger RYGBP patients (Giordano S, Marczuk P, Level of Evidence 1++) [ 55 , 88 ], although with LSG it seems that the loss is similar (Haywood C, Level of Evidence 1−) [ 63 ]. Consequently, RYGBP should be discouraged in people over 65, especially in cases of high cardiovascular risk (Giordano S, Marczuk P, Level of Evidence 1++, grade of recommendation A) [ 55 , 88 ], and LSG could be considered as an option (Haywood C, Level of Evidence 1−, grade of recommendation B) [ 63 ].…”

“…References of the studies reviewed in this section: [ 8 , 9 , 19 , 20 , 23 , 24 , 29 , 33 , 40 , 41 , 46 , 47 , 48 , 49 , 53 , 54 , 55 , 56 , 60 , 63 , 64 , 66 , 68 , 69 , 72 , 86 , 88 , 89 , 91 , 92 , 93 , 94 , 100 , 102 , 106 , 107 , 108 , 109 , 112 , 114 , 117 , 118 , 119 , 135 , 137 , 139 , 140 , 144 , 149 , 158 , 159 ].…”