title: Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities.
abstract: BACKGROUND
  Bariatric surgery has not been routinely presented as an option for patients over 60 years of age. Part of the reason is the long-standing perception that there is additional risk. Additionally, until its recent ruling, Medicare was inconsistent in its coverage, thus making it difficult for some beneficiaries to gain access to the procedures. The aim of this study was to evaluate the perioperative morbidity in our patients who were 60 years of age or older who underwent a laparoscopic gastric bypass Roux-en-Y (LGBRY). We also report the impact of surgery on five objectively graded comorbidities in the early postoperative period.
  
  
  METHODS
  Our prospectively maintained database was used to identify and report on all patients operated on at our program from January 2002 through January 2007.
  
  
  RESULTS
  One hundred twenty patients were identified with 100% follow-up through the perioperative phase and 85% follow-up at 12 months. The mean age was 62 years (range 60-74) with a mean body mass index of 43 kg/m(2) (range 34-70). All patients underwent an LGBRY. There was no 30-day mortality. Perioperative complications included: 13 strictures, one abscess, two wound infections, three ulcers, two small bowel obstructions, three bleeding episodes in patients who required coumadin, and atrial fibrillation in two patients. The five graded/measurable comorbid conditions (preop/postop) were diabetes mellitus type II (68/17), hypertension (86/10), obstructive sleep apnea requiring continuous positive airway pressure (CPAP; 48/3), hypercholesterolemia (106/18), and hypertriglyceridemia (60/5).
  
  
  CONCLUSIONS
  LGBRY can be done safely in patients over 60 years of age in an experienced bariatric program, even in patients with relatively high risk based on their comorbid conditions preoperatively. Resolution of associated comorbidities far exceeds that found with any other treatment modality.
authors.affiliation: Bariatric Program, Wittgrove Bariatric Center, Scripps Memorial Hospital, 9834 Genesee Avenue, Suite 328, La Jolla, CA 92037, USA. acwmd@lapbypass.com
authors.forename: Alan C
authors.initials: AC
authors.lastname: Wittgrove
authors.forename: Tracy
authors.initials: T
authors.lastname: Martinez
mesh_terms: D000367:Age Factors; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D015992:Body Mass Index; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
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