Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Obes Surg. 2011 Aug;21(8):1180-7. doi: 10.1007/s11695-011-0454-6.
Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder.
Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1- and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared.
The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p = ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p = 0.02), but late complications were more common in younger patients, 17% vs 44%, p = ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p = ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p = ns.
Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and hypoalbuminemia. Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein.
减重手术已被证明对 60 岁以上患者是安全的，尤其是考虑到其能解决多种合并症。袖状胃切除术被认为比胃旁路术（GBP）更安全，比胃带术更有效，且不良反应症状更少。与 GBP 相比，减重效果可能较为温和，但对维生素的影响也可能较轻。
自 2007 年以来，我们前瞻性地收集了 55 例接受袖状胃切除术患者的 12 个月随访数据，其中 12 例患者年龄超过 59 岁。术后使用维生素和钙补充剂。通过标准方案记录住院期间、术后 1 个月和 12 个月的手术恢复情况，包括实验室检查。比较了 59 岁以上和以下患者的结果。
两组患者术前体重和减重效果相当。手术时间较短，老年患者的住院时间较长，但差异无统计学意义（p=ns）。无手术死亡病例。高龄组早期主要并发症更为常见，占 42%，而年轻组占 9%（p=0.02），但年轻组晚期并发症更为常见，占 17%，而高龄组占 44%，差异无统计学意义（p=ns）。早期并发症主要为出血，但并未延长住院时间，也无需再次手术或内镜治疗。两组患者术后 12 个月的体重减轻和合并症缓解情况相当。然而，高龄组维生素缺乏和低白蛋白血症更为常见，分别占 42%和 23%，蛋白质缺乏和低白蛋白血症分别占 44%和 29%，差异无统计学意义（p=ns）。高龄患者手术相关不良反应更多，占 25%，而年轻患者精神相关不良反应更多，占 9%，差异无统计学意义（p=ns）。
袖状胃切除术对老年肥胖患者有效且安全。减重效果与年轻患者相当，足以缓解大多数患者的合并症。通过标准化营养补充，高龄患者更常出现维生素缺乏和低白蛋白血症。尽管老年肥胖患者的手术治疗是安全的，但考虑到维生素和蛋白质，他们的术后护理要求较高。
