Bergeat Damien, Lechaux David, Ghaina Adil, Thibault Ronan, Bouygues Vianney
Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.
Université de Rennes 1, Rennes, France.
Obes Surg. 2017 Jun;27(6):1414-1422. doi: 10.1007/s11695-016-2517-1.
Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes.
The aim of this case-control study is to evaluate global results of LBS in patients ≥60 years (yr) with a matched case control study.
All patients ≥60 years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40-59 years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90 days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed.
Fifty-five patients ≥60 year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40 year and patients 40-59 year (n = 55 each). Patients ≥60 year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P = 0.01), no difference in major complication rate was observed (P = 0.43). At 24 months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P = 0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60 year After a mean follow-up of 27 months, BAROS score (filled in by 82% of patients) was lower in patients ≥60 years (P = 0.01).
Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.
老年肥胖患者的腹腔镜减肥手术（LBS）术后效果仍存在争议。
本病例对照研究旨在通过匹配病例对照研究评估60岁及以上患者LBS的整体结果。
本回顾性研究纳入了2009年1月至2014年1月期间在本中心接受LBS治疗的所有60岁及以上患者。根据体重指数（BMI）、手术方式、年份和既往LBS病史，将他们与年龄小于40岁和40 - 59岁的患者进行匹配（1:2）。分析LBS术后前90天的并发症、微量营养素和矿物质缺乏情况以及减肥分析与报告结果系统（BAROS）。
55例60岁及以上患者（40例行袖状胃切除术，14例行单吻合口胃旁路术，1例行胃旁路修复术）与年龄小于40岁和40 - 59岁的患者（各55例）进行了匹配。60岁及以上患者在基线时存在更多与肥胖相关的合并症。除出血并发症外（P = 0.01），主要并发症发生率无差异（P = 0.43）。在24个月时，老年患者的%EWL低于其他患者（分别为76.3%、82.2%和89.7%；P = 0.009）。60岁及以上患者铁和维生素B12缺乏的发生率较低。平均随访27个月后，60岁及以上患者的BAROS评分（82%的患者填写）较低（P = 0.01）。
尽管体重减轻较少、术后并发症发生率较低且BAROS结果较差，但LBS在选定的老年患者中仍保持可接受的获益 - 风险平衡，不应仅以年龄为由拒绝手术。需要进一步研究评估LBS在老年患者中的长期益处。
