Weight Loss Is Higher With LRYGB vs SG in Older Adults

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with significant weight loss compared with sleeve gastrectomy (SG) in patients age 65 years or older, according to a recent study. However, the overall rate of complications was doubled with LRYGB vs SG.

The majority of previous bariatric studies in older adults focus on older procedures with limited follow-up and equivocal results.
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To compare the effects of LRYGB and SG in older patients, the researchers assessed participants who had received LRYGB (n = 177) or SG (n = 252) between January 1, 2010, and March 15, 2015. Mean patient age was 67 years, and mean body mass index (BMI) was 42.6 kg/m². Additionally, 70% of patients were female, and 64% of patients were non-Hispanic white. Follow-up lasted 4 years in 322 (75%) of patients.

Outcomes of the study included changes in weight up to 4 years post-surgery; the rates of mortality after 30, 90, and 365 days; early complication rates (30 days or fewer post-surgery); and late complication rates (31-365 days post-surgery). To control for random assignment, cases of SG and LRYGB were propensity matched at the time of surgery for gender, race or ethnicity, year of procedure, BMI, the presence of diabetes and/or hypertension, and the overall burden of comorbidities.

After a median 4-year follow-up, results indicated that participants who received LRYGB had lost significantly more weight than those who received SG. Rates of mortality were similar between groups. However, the overall rate of complications was higher among participants who received LRYGB (30.5%) vs SG (15.4%).

“Elderly patients lost significantly more weight with LRYGB compared with SG,” the researchers concluded. “Further studies will be necessary to determine if the long-term effects of greater weight loss warrant the increased risk involved with LRYGB.”

—Christina Vogt

Reference:

Casillas RA, Kim B, Fischer H, Zelada Getty JL, Um SS, Coleman KJ. Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults. Surg Obes Rel Dis. 2017;13(9):1476-1483. http://dx.doi.org/10.1016/j.soard.2017.03.011.