title: Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. marja.leivonen@hus.fi
authors.forename: Marja Kaarina
authors.initials: MK
authors.lastname: Leivonen
authors.forename: Anne
authors.initials: A
authors.lastname: Juuti
authors.forename: Nabil
authors.initials: N
authors.lastname: Jaser
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
mesh_terms: D000367:Age Factors; D000368:Aged; D001361:Avitaminosis / Q000453:epidemiology; D002118:Calcium / Q000008:administration & dosage; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011178:Postgastrectomy Syndromes / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014815:Vitamins / Q000008:administration & dosage; D015431:Weight Loss
chemical_list: D014815:Vitamins; D002118:Calcium