First Ecuadorian report on bariatric surgery in the elderly
DOI:
https://doi.org/10.47464/MetroCiencia/vol28/3/2020/25-31Keywords:
Bariatric surgery, obesity, elderly, weight loss, complications, safetyAbstract
Background: bariatric surgery is currently the most effective obesity treatment, with metabolic benefits in addition to weight loss. Adequate preoperative evaluation and surgical planning are essential for success, especially in elderly patients. Objective: determine up to 2-year weight change, metabolic benefits and safety of bariatric surgery in the elderly. Methodology: older adults ≥ 65y who underwent laparoscopic bariatric surgery at a private tertiary referral hospital in Ecuador, between 2010 and 2019, were included. Weight loss, improvement of endocrine and metabolic comorbidities, and surgical complications were measured up to two years after the procedure. Results: sixteen patients were included. The mean age was 68.5 years (SD: ± 4.2); 12 (75%) were female. Gastric bypass was performed in 56.25% of patients; sleeve gastrectomy in 37.5%, and 6.25% had a revision procedure. Thirteen patients completed a two-year follow-up, where percentage of total weight loss (%TWL) was 31.5% (SD: ±3.0%), and percentage of excess weight loss (%EWL) was 72.9% (SD: ± 11.0) with gastric bypass; and 22.7% (SD: ±3.2%) and 65.6% (SD: ± 13.0) with sleeve gastrectomy, respectively. Remission for type 2 diabetes mellitus (T2DM) was 80%, 62.5% for hypertension (HT) and 60% for dyslipidemia. Fifty percent of postoperative complications were Grade I. Conclusion: this is the first report from a tertiary referral hospital in Ecuador about bariatric surgery in the elderly demonstrating its safety with a low complication rate, effectiveness as a short-term treatment for obesity and its comorbidities, and benefits similar to those presented globally in younger subjects.
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References
Cazzo E, Gestic MA, Utrini MP, et al. Bariatric surgery in the elderly: A narrative review. Rev Assoc Med Bras. 2017;63(9):787-792. doi:10.1590/1806-9282.63.09.787 PMID: 29239469
Bowers B. Caregiving in an Aging World: Quality of Care and Quality of Life. In: 29th International Nursing Research Congress Melbourne-Australia. ; 2018.
Diario La Hora. En Ecuador el 59% de adultos sufren de obesidad : País : La Hora Noticias de Ecuador, sus provincias y el mundo. https://lahora.com.ec/noticia/1101051854/en-ecuador-el-59_-de-adultos-sufren-de-obesidad. Published 2010. Accessed June 24, 2020.
INEC. Encuesta de Salud, Bienestar del Adulto Mayor. https://www.ecuadorencifras.gob.ec/encuesta-de-salud-bienestar-del-adulto-mayor/. Accessed June 24, 2020.
Freire WB, Ramírez MJ, Belmont P, et al. Encuesta Nacional de Salud y Nutrición. ENSANUT-ECU 2011-2013. Vol 1. Ministerio de Salud Pública; 2013.
Freire WB, Silva-Jaramillo KM, Ramírez-Luzuriaga MJ, Belmont P, Waters WF. The double burden of undernutrition and excess body weight in Ecuador. Am J Clin Nutr. 2014;100(6):1636S-43S. doi:10.3945/ajcn.114.083766 PMID: 25411306
Zamboni M, Mazzali G. Obesity in the elderly: An emerging health issue. Int J Obes. 2012;36(9):1151-1152. doi:10.1038/ijo.2012.120 PMID: 22964828
WHO. Overweight and obesity. https://www.who.int/gho/ncd/risk_factors/overweight_obesity/obesity_adults/en/. Published 2018. Accessed June 24, 2020.
Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015;33(7):673-689. doi:10.1007/s40273-014-0243-x
WHO. Obesity: preventing and managing the global epidemic. https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/. Published 2015. Accessed June 24, 2020.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641-651. doi:10.1056/NEJMoa1600869. PMID: 28199805
Pajecki D, Santo MA, Joaquim HDG, et al. Bariatric Surgery in the Elderly: Results of a mean follow-up of five years. Arq Bras Cir Dig. 2015;28:15-18. doi:10.1590/S0102-6720201500S100006
Rigamonti AE, De Col A, Tamini S, et al. Multidisciplinary integrated metabolic rehabilitation in elderly obese patients: Effects on cardiovascular risk factors, fatigue and muscle performance. Nutrients. 2019;11(6). doi:10.3390/nu11061240 PMID: 31159183
Albán-Tigre JL, Villarreal-Juris AP, Puente-Galeas WM, Padilla-Paredes H, Albán-Tigre CA, Yamira-Herrera G. Seguridad y Resultados de Cirugía Bariátrica en Adolescentes: Seguimiento a dos años. Rev la Soc Peru Cirugía Endoscópica. 2019;1(2):52-56. ISSN: 2664-2417
Susmallian S, Raziel A, Barnea R, Paran H. Bariatric surgery in older adults: Should there be an age limit? Medicine (Baltimore). 2019;98(3):e13824. doi:10.1097/MD.0000000000013824 PMID: 30653091
Gebhart A, Young MT, Nguyen NT. Bariatric surgery in the elderly: 2009-2013. Surg Obes Relat Dis. 2015;11(2):393-398. doi:10.1016/j.soard.2014.04.014 PMID: 25130515
Nguyen NT, De Maria EJ, Ikramuddin S, Hutter MM. The SAGES Manual: A Practical Guide to Bariatric Surgery. Springer New York; 2008. doi:10.1007/978-0-387-69171-8
Takahashi H, Allemang MT, Strong AT, et al. Completion gastrectomy with esophagojejunostomy for management of complications of benign foregut surgery. J Laparoendosc Adv Surg Tech A. 2018;28(8):983-989. doi:10.1089/lap.2017.0540 PMID: 29493349
Sabench Pereferrer F, Molina López A, Vives Espelta M, et al. Weight Loss Analysis According to Different Formulas after Sleeve Gastrectomy With or Without Antral Preservation: a Randomised Study. Obes Surg. 2017;27(5):1254-1260. doi:10.1007/s11695-016-2454-z PMID: 27995517
Corcelles R, Boules M, Froylich D, et al. Total Weight Loss as the Outcome Measure of Choice After Roux-en-Y Gastric Bypass. Obes Surg. 2016;26(8). doi:10.1007/S11695-015-2022-Y PMID: 26803753
Grover BT, Morell MC, Kothari SN, Borgert AJ, Kallies KJ, Baker MT. Defining Weight Loss After Bariatric Surgery: a Call for Standardization. Obes Surg. 2019;29(11):3493-3499. doi:10.1007/s11695-019-04022-z PMID: 31256357
Larrad Á, Sánchez-Cabezudo C. Indicadores de calidad en cirugía bariátrica y criterios de éxito a largo plazo. Cir Esp (Ed impr). 2004:301-304. ID: ibc-31922
Dimeglio C, Becouarn G, Topart P, Bodin R, Buisson JC, Ritz P. Weight loss trajectories after bariatric surgery for obesity: Mathematical model and proof-of-concept study. J Med Internet Res. 2020;22(3). doi:10.2196/13672 PMID: 32149710
Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489-506. doi:10.1016/j.soard.2015.02.003 PMID: 26093765
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi:10.1097/01.sla.0000133083.54934.ae PMID: 15273542
Clavien PA, Barkun J, De Oliveira ML, et al. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187-196. doi:10.1097/SLA.0b013e3181b13ca2 PMID: 19638912
Welsh LK, Luhrs AR, Davalos G, et al. Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry. Obes Surg. 2020;30(8). doi:10.1007/s11695-020-04657-3 PMID: 32388704
Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: The diabetes surgery study randomized clinical trial. JAMA - J Am Med Assoc. 2013;309(21):2240-2249. doi:10.1001/jama.2013.5835 PMID: 23736733
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678 PMID: 30879355
Beamish AJ, Olbers T, Kelly AS, Inge TH. Cardiovascular effects of bariatric surgery. Nat Rev Cardiol. 2016;13(12):730-743. doi:10.1038/nrcardio.2016.162 PMID: 27762312
Instituto Mexicano del Seguro Social. Diagnóstico y tratamiento de dislipidemias. In: Centro Nacional de Excelencia Tecnológica en Salud, ed. Catálogo Maestro de Guías de Práctica Clínica. México D.F.; 2016. ISBN: 9786077790624
Martínez Figueroa R, Martínez Figueroa C, Calvo Rodriguez R, Figueroa Poblete D. Osteoartritis (artrosis) de rodilla. Rev Chil Ortop y Traumatol. 2015;56(3):45-51. doi:10.1016/j.rchot.2015.10.005 ISSN: 07164548
Haywood C, Sumithran P. Treatment of obesity in older persons-A systematic review. Obes Rev. 2019;20(4):588-598. doi:10.1111/obr.12815 PMID: 30645010
Concors SJ, Ecker BL, Maduka R, et al. Complications and Surveillance After Bariatric Surgery. Curr Treat Options Neurol. 2016;18(1):1-12. doi:10.1007/s11940-015-0383-0 PMID: 26860932
Quirante FP, Montorfano L, Rammohan R, et al. Is bariatric surgery safe in the elderly population? Surg Endosc. 2017;31(4):1538-1543. doi:10.1007/s00464-016-5050-3 PMID: 28039650
Koh CY, Inaba CS, Sujatha-Bhaskar S, Nguyen NT. Outcomes of laparoscopic bariatric surgery in the elderly population. Am Surg. 2018;84(10):1600-1603. PMID: 30747677
Bernstein A. Emerging patterns in overweight and obesity in Ecuador. Rev Panam Salud Publica/Pan Am J Public Heal. 2008;24(1):71-74. doi:10.1590/S1020-49892008000700010
Vinan-Vega M, Diaz Vico T, Elli EF. Bariatric Surgery in the Elderly Patient: Safety and Short-time Outcome. A Case Match Analysis. Obes Surg. 2019;29(3):1007-1011. doi:10.1007/s11695-018-03633-2 PMID: 30536201
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: A systematic review and meta-analysis. J Am Med Assoc. 2004;292(14):1724-1737. doi:10.1001/jama.292.14.1724 PMID: 15479938
Zambrano, A., Gaviria, A., Cobos-Navarrete, S. et al. The three-hybrid genetic composition of an Ecuadorian population using AIMs-InDels compared with autosomes, mitochondrial DNA and Y chromosome data. Sci Rep 9, 9247 (2019). https://doi.org/10.1038/s41598-019-45723-w
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Copyright (c) 2020 Andrea Patricia Villarreal Juris, Jorge Luis Albán Tigre, Hernán Isaí Padilla Paredes, Cristina Joelle Ponce Ontaneda, Alfredo Daniel Guerrón Cruz, William Mesías Puente Galeas, Estefany Cristina Garcés Delgado, Máximo Vicente Torres Guaicha, Amílcar Omar Herrera Cevallos, Glenda Yamira Herrera Cevallos
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