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Alharran AM, Alenezi YY, Hammoud SM, Alshammari B, Alrashidi M, Alyaqout FB, Almarri A, Alharran YM, Alazemi MH, Allafi F, Ahmad Al Sadder K. Efficacy of LigaSure Versus Harmonic Devices in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e57478. [PMID: 38566782 PMCID: PMC10987252 DOI: 10.7759/cureus.57478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/04/2024] Open
Abstract
Our goal is to conduct a thorough systematic review and meta-analysis of comparative studies to evaluate the efficacy of LigaSure (Valleylab, Boulder, CO) compared with Harmonic (Ethicon Endo-Surgery, Inc., Cincinnati, OH) devices in patients undergoing laparoscopic sleeve gastrectomy (LSG). Our search strategy, from inception until March 1, 2024, involved multiple databases, including the Cochrane Controlled Register of Trials (CENTRAL), Web of Science (WOS), PubMed, Scopus, and Google Scholar. We evaluated randomized clinical trials using the Cochrane Risk of Bias tool for randomized trials (RoB-2) tool and non-randomized studies using the Risk of Bias In Non-randomized Studies for Interventions (ROBINS-I) tool. The primary outcomes assessed were operative time, mean length of hospital stay, and the rates of intraoperative complications such as bleeding, organ injury, leakage, and hematoma formation. Additionally, we collected data on postoperative complications, including bleeding, abscess formation, leakage, fever (>38°C), and reoperation rates. Data were analyzed using random-effects models and reported as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) using Review Manager software (RevMan, version 5.4 for Windows, The Cochrane Collaboration, 2020). Four studies, comprising two randomized clinical trials (RCTs) and two retrospective cohort studies, involving a total of 692 patients, were included in the analysis. Both the operative time and length of hospital stay did not significantly differ between the LigaSure and Harmonic groups (p>0.05). The pooled analysis also revealed no significant difference between the LigaSure and Harmonic groups in terms of intraoperative and postoperative complications (p>0.05). In conclusion, our systematic review and meta-analysis found no significant statistical or clinical differences between LigaSure and Harmonic devices in terms of operative outcomes and complication rates in patients undergoing LSG.
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Affiliation(s)
- Abdullah M Alharran
- Medicine and Surgery, College of Medicine, Arabian Gulf University, Manama, BHR
| | - Yaqoub Y Alenezi
- Medicine and Surgery, College of Medicine, Arabian Gulf University, Manama, BHR
| | | | - Bandar Alshammari
- Medicine and Surgery, Faculty of Medicine, University of Jordan, Amman, JOR
| | - Mohammed Alrashidi
- Medicine and Surgery, Faculty of Medicine, University of Jordan, Amman, JOR
| | - Fajer B Alyaqout
- Medicine and Surgery, College of Medicine, Arabian Gulf University, Manama, BHR
| | - Abdulhadi Almarri
- Medicine and Surgery, College of Medicine, Arabian Gulf University, Manama, BHR
| | - Yousef M Alharran
- Medicine and Surgery, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Mohammed H Alazemi
- Medicine and Surgery, Faculty of Medicine, Alexandria University, Alexandria, EGY
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2
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Lima RCD, Rodrigues TMDS, Scheibe CL, Campelo GP, Pinto LEV, Valadão GJC, Carvalho GPCD, Machado Junior MRD, Valadão JA, Lima PCRD, Leal PDC, Oliveira CMBD, Moura ECR. Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment. Acta Cir Bras 2021; 36:e360203. [PMID: 33624720 PMCID: PMC7902054 DOI: 10.1590/acb360203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of
obese patients, adherence to clinical follow-up and the influence of factors
such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with
patients undergoing vertical gastrectomy, operated at Hospital São Domingos,
between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%)
and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was
56.18%. Among adherent patients (n = 117; 43.82%), most patients were female
(n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body
mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72
kg/m2. Both BMI and excess weight (EW) showed a statistically
significant difference between pre- and postoperative period. Percentage of
excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients.
Older patients had a statistically significant lower % EWL compared to the
other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with
significant weight loss.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Plinio da Cunha Leal
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
| | | | - Ed Carlos Rey Moura
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
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3
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Haywood C, Sumithran P. Treatment of obesity in older persons-A systematic review. Obes Rev 2019; 20:588-598. [PMID: 30645010 DOI: 10.1111/obr.12815] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
The study aims to systematically review the available evidence regarding weight loss interventions (lifestyle, surgical, and pharmacological) for obesity in adults aged over 60 years. A search of prospective, randomized studies took place in January 2018, on Medline (Web of Science) and PubMed databases. Search terms included the following: elderly, obese, hypocaloric, pharmacotherapy, and bariatric surgery. Abstracts were screened for eligibility. A total of 256 publications regarding lifestyle interventions were identified; of these, 69 studies were eligible. As no eligible studies were identified for pharmacotherapy or bariatric surgery, the search was broadened to include non- randomized studies. Four pharmacotherapy and 66 surgery studies were included. Lifestyle intervention had similar weight loss efficacy in older compared with younger people, with positive effects on a number of relevant outcomes, including physical function and cardiovascular parameters. There was little data regarding obesity pharmacotherapy in older persons. The available data for bariatric surgery indicate comparable weight loss and resolution of type 2 diabetes, with similar or slightly higher complication rates in older compared with younger people. Older age alone should not be considered a contraindication to intensive lifestyle or surgical intervention for obesity. There are insufficient data to guide clinical decisions regarding obesity pharmacotherapy in older people.
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Affiliation(s)
- Cilla Haywood
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.,Department of Aged Care, Austin Health, Heidelberg, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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4
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Velotti N, Manigrasso M, Di Lauro K, Vitiello A, Berardi G, Manzolillo D, Anoldo P, Bocchetti A, Milone F, Milone M, De Palma GD, Musella M. Comparison between LigaSure™ and Harmonic® in Laparoscopic Sleeve Gastrectomy: A Single-Center Experience on 422 Patients. J Obes 2019; 2019:3402137. [PMID: 30719344 PMCID: PMC6335858 DOI: 10.1155/2019/3402137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND New laparoscopic devices, such as electrothermal bipolar-activated devices (LigaSure™ (LS)) or ultrasonic systems (Harmonic® scalpel (HS)), have been applied recently to bariatric surgery allowing to reduce blood loss and surgical risks. The aim of this study was to retrospectively compare intraoperative performance of HS and LS, postoperative results, and clinical outcomes in a large cohort of patients undergoing LSG. METHODS Data from 422 morbidly obese patients undergoing LSG in our Bariatric Unit at the Advanced Biomedical Sciences Department of the "Federico II" University of Naples (Italy) between January 2009 and December 2017 were retrospectively analyzed. Subjects were divided into two groups (HS and LS), and operative time, intraoperative complications, and postoperative (within 30 days from surgery) complications were compared. Bleeding from the omentum or from the staple line, use of hemostatic clips, and absorbable hemostat were recorded as intraoperative complications; hemorrhages, abscess formation, gastric leaks, fever, and mortality were considered as postoperative complications. RESULTS Statistical analysis showed no difference in terms of baseline demographics between the two cohorts. Operative time (48 ± 9 vs 49 ± 6 min, p=0.646) and the rates of intraoperative and postoperative complications did not significantly differ between groups. CONCLUSION Harmonic® and LigaSure™ are both useful tools in bariatric surgery, and these two advanced power devices are user-friendly and can facilitate surgeon work; from this point of view, the choice of the energy device should be based on the preference of the surgeon and on the hospital costs policy and availability.
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Affiliation(s)
- N. Velotti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Manigrasso
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - K. Di Lauro
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - A. Vitiello
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - G. Berardi
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - D. Manzolillo
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - P. Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - A. Bocchetti
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - F. Milone
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Milone
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - G. D. De Palma
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
| | - M. Musella
- Department of Advanced Biomedical Sciences, “Federico II” University, Via Pansini 5, 80131 Naples, Italy
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Stanford FC, Toth AT, Shukla AP, Pratt JS, Cena H, Biino G, Aronne LJ. Weight Loss Medications in Older Adults After Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multicenter Study. Bariatr Surg Pract Patient Care 2018; 13:171-178. [PMID: 30595995 DOI: 10.1089/bari.2018.0037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Weight loss medications are effective to confer additional weight loss after bariatric surgery in the general population, but they have not been evaluated in adults 60 years of age and older. We performed a retrospective study identifying 35 patients who were ≥60 years old and had undergone Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2000 to 2014, and were subsequently prescribed weight loss medications. Linear regression analyses were performed to determine beta coefficients of certain predictor variables being associated with weight loss. Patients lost weight on medications with an average body mass index (BMI) change of -2.74 kg/m2, standard deviation = 2.6 kg/m2. RYGB patients lost a greater percentage of BMI on medication than SG (SG; -1.38 ± 1.49 kg/m2 and RYGB; -3.37 ± 2.83 kg/m2, p = 0.0372). Patients with hypertension were less likely to lose weight on medications (β = 16.76, p = 0.004, and 95% confidence interval = 5.85-27.67). Weight loss medications are a useful treatment to confer additional weight loss in adults 60 years of age and older after RYGB and SG.
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Affiliation(s)
- Fatima Cody Stanford
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Alexander T Toth
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Janey S Pratt
- Department of Surgery, Lucille Packard Children's Hospital and Stanford University School of Medicine, Palo Alto, California
| | - Hellas Cena
- Unit of Human Nutrition and Dietetics, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Ginevra Biino
- Institute of Molecular Genetics, National Research Council of Italy, Pavia, Italy
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York
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6
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Bianco P, Rizzuto A, Velotti N, Bocchetti A, Manzolillo D, Maietta P, Milone M, Amato M, Conzo G, Buonomo O, Petrella G, Musella M. Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years. MINERVA CHIR 2018; 75:77-82. [PMID: 29963791 DOI: 10.23736/s0026-4733.18.07757-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) represents the most performed bariatric surgical procedure worldwide. Morbid Overweight in elderly patients is becoming a significant health problem even in Italy. As well as in younger age groups, bariatric surgery could be indicated even in this subset of patients. However the advantages and results of LSG in patients over 60 years old have received minimal attention. METHODS The records of 375 patients underwent LSG between 2008 and 2016 were reviewed. In the entire series 18 patients were aged 60 years or older at the time of surgery. Since a 3 years follow-up was available for 12 patients out of the 18 aged over 60 we included in the study only these. General epidemiologic data, clinical findings, BMI and comorbidities surgical treatment and follow-up data were collected; postoperative measurements such as operative time, intraoperative complications, mortality rate, length of stay, incidence of early and late complications, Body mass Index (BMI), excess weight loss rate (EWL%) and comorbidities resolution were also recorded. RESULTS LSG was successfully performed for all geriatric patients. Global complications rate was 16.6% At 3 years mean BMI was 34.4±3.8 with a mean EWL% 66.1±31.9. Postoperative resolution of obesity comorbidities was observed; Hypertension (71.4%), type 2 Diabetes Mellitus (T2DM) (50.0%), obstructive sleep apnea syndrome (OSAS) (66.6%) respectively. No intraoperative complications or mortality were recorded. CONCLUSIONS LSG offered cure in geriatric patients affected by morbid obesity for weight loss and comorbidities resolution. Larger studies are necessary to analyze and minimize the incidence of postoperative complications associated to this surgical procedure in elderly patients.
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Affiliation(s)
- Paolo Bianco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessio Bocchetti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Domenico Manzolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Milone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Amato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Conzo
- Department of Cardiothoracic and Respiratory Sciences, Luigi Vanvitelli University, Naples, Italy
| | - Oreste Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy
| | | | - Mario Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
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7
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Chouillard E, Alsabah S, Chahine E, Saikaly E, Debs T, Kassir R. Changing the quality of life in old age bariatric patients. Cross-sectional study for 79 old age patients. Int J Surg 2018; 54:236-241. [DOI: 10.1016/j.ijsu.2018.04.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/05/2018] [Accepted: 04/28/2018] [Indexed: 01/17/2023]
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8
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Velotti N, Bianco P, Bocchetti A, Milone M, Manzolillo D, Maietta P, Amato M, Buonomo O, Petrella G, Musella M. Acute complications following endoscopic intragastric balloon insertion for treatment of morbid obesity in elderly patients. A single center experience. MINERVA CHIR 2018; 75:72-76. [PMID: 29658677 DOI: 10.23736/s0026-4733.18.07712-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity is a serious disease, with an increasing incidence also among subjects over 60 years old; surgical management has proven to be the most effective in the production of significant and durable weight loss. Intragastric balloon (IGB) treatment promotes a reduction of five to nine Body Mass Index (BMI) units in 6 months with an impressive improvement of obesity-associated comorbidities. METHODS Two hundred and twenty-five patients, 106 men (47.1%) and 119 women (52.9%), were evaluated at our institution to be submitted to a IGB positioning. Of these, 12 patients (8 women and 4 men) were more than 60 years old. For all patients BMI, comorbidities, weight loss and complications were recorded. χ2 test was used to evaluate differences in complications rate between elderly and other patients. RESULTS For the 12 elderly patients, we recorded a mean excess weight loss rate (EWL%) of 31.4. About complications, we recorded 2 severe esophagitis requiring IGB removal and 1 late gastric perforation. A higher complications rate was found in elderly population and the comparison with other patients revealed a significant difference (P<0.001). CONCLUSIONS Our results underline that IGB treatment in elderly patients is safe and effective in terms of weight loss and improvement in comorbidities. IGB can cause complications which, sometimes, can be severe such as esophageal damage and gastric perforation. For the management of complications, we highly recommend a close follow-up in all patients and a deepened instrumental study in every suspect case.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
| | - Paolo Bianco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessio Bocchetti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Milone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Domenico Manzolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Amato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Oreste Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy
| | | | - Mario Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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9
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The Effectiveness and Safety of Sleeve Gastrectomy in the Obese Elderly Patients: a Systematic Review and Meta-Analysis. Obes Surg 2017; 26:3023-3030. [PMID: 27714526 DOI: 10.1007/s11695-016-2396-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This systematic review was performed to compare the effectiveness and safety of SG in the obese elderly patients with the young ones. METHODS Cohort studies that compared outcomes among old and young patients who had undergone SG were included. Summary odds ratios were estimated using a random effect model. RESULTS Eleven studies were included. Old patients had a worse outcome in percentage of excess weight loss than the young ones (SMD -0.39, 95 % CI -0.55 to -0.24). No significant differences were recorded in resolution of co-morbidities: type 2 diabetes mellitus (OR 1.60, 95 % CI 0.84-3.05), hypertension (OR 1.05, 95 % CI 0.65-1.68), dyslipidemia (OR 1.38, 95 % CI 0.68-2.80), OSAS (OR 0.64, 95 % CI 0.30-1.34), or postoperative complications (OR 0.89, 95 % CI 0.51-1.55) between the elderly and the young who had undergone SG. CONCLUSIONS SG was effective for weight loss and resolution of co-morbidities with low complication rate in the obese elderly patients.
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10
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Maietta P, Milone M, Coretti G, Galloro G, Conzo G, Docimo G, Ruggiero R, Musella M. Retrieval of the gastric specimen following laparoscopic sleeve gastrectomy. Experience on 275 cases. Int J Surg 2015; 28 Suppl 1:S124-7. [PMID: 26708855 DOI: 10.1016/j.ijsu.2015.12.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/27/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023]
Abstract
Severe obesity leads to a high incidence of complications and a decrease in life expectancy, especially among younger adults. Laparoscopic sleeve gastrectomy (LSG) first intended as the first step of biliopancreatic diversion with duodenal switch is gaining a per-se procedure role because of its effectiveness on weight loss and comorbidity resolution. Different techniques have been described for specimen extraction in LSG. In this article we report the technique adopted in 275 LSGs performed in our department. In the first 120 LSGs performed from 2007, the specimen was extracted through a mini laparotomy. In the following 155 cases the technique has been simplified: the grasped specimen has been withdrawn through the 15 mm trocar site. We registered in the fist group six cases of wound infection (5%), ten cases of hematoma (8.3%) and four cases of port site hernia (3.3%). In the second group only one case of hematoma (0.6%, p = 0.01) but no cases of wound infection (p = 0.01) or port site hernia, (p = 0.03) although we registered a specimen perforation during retrieval in 16 patients, were reported. The technique described in the 155 cases of the control group has shown to be more effective than the technique we used in the case group, allowing significantly lower operative time (112.9 ± 1.0 vs 74.9 ± 9.1 p < 0.001) and complications, and providing unchanged costs.
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Affiliation(s)
- P Maietta
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - M Milone
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - G Coretti
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - G Galloro
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy.
| | - G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences, "SUN" Naples Second University, Naples, Italy.
| | - G Docimo
- Department of Medical, Surgical, Neurological and Metabolical Sciences, "SUN" Naples Second University, Naples, Italy.
| | - R Ruggiero
- Department of Medical, Surgical, Neurological and Metabolical Sciences, "SUN" Naples Second University, Naples, Italy.
| | - M Musella
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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11
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Morbidity Rates and Weight Loss After Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding in Patients Older Than 60 Years old: Which Procedure to Choose? Obes Surg 2015. [DOI: 10.1007/s11695-015-1824-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Michaud A, Marchand GB, Nadeau M, Lebel S, Hould FS, Marceau S, Lescelleur O, Biron S, Tchernof A, Biertho L. Biliopancreatic Diversion with Duodenal Switch in the Elderly: Long-Term Results of a Matched-Control Study. Obes Surg 2015; 26:350-60. [DOI: 10.1007/s11695-015-1772-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Abstract
The prevalence of obesity is increasing in the elderly population. The primary goal of obesity therapy in elderly is the improvement of metabolic complications and the prevention of severe functional limitations. Clinical studies could demonstrate that the combination of nutritional intervention and physical exercise is of advantage to improve the functional status. Study evidence about the efficacy and safety of medication for weight reduction in elderly is limited, and the risks of bariatric surgery outweigh the possible benefits. The test battery of the comprehensive geriatric assessment is an important tool to determine body composition, nutritional status as well as functional and cognitive capacities of the elderly patient. These results are of central importance for the treatment plan and goals.
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Affiliation(s)
- Monika Lechleitner
- a Department of Internal Medicine, Hospital Hochzirl, A-6170 Zirl, Austria
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14
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15
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Daigle CR, Andalib A, Corcelles R, Cetin D, Schauer PR, Brethauer SA. Bariatric and metabolic outcomes in the super-obese elderly. Surg Obes Relat Dis 2015; 12:132-7. [PMID: 26077696 DOI: 10.1016/j.soard.2015.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/29/2015] [Accepted: 04/08/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Numerous reports address bariatric outcomes in super-obese or elderly patients, but data addressing this high-risk combination is lacking. OBJECTIVE The objective of this study was to assess outcomes of bariatric surgery in the super-obese elderly. SETTING Academic institution, United States. METHODS All primary bariatric cases performed on patients aged 65 years or older with a body mass index (BMI) ≥ 50 kg/m(2) were retrospectively analyzed. Surgical approaches included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). RESULTS Thirty patients (26 female, 4 male) with a mean age of 67.1 ± 2.7 years and BMI of 55.9 ± 3.9 kg/m(2), who had LRYGB (n = 16), LSG (n = 6), or LAGB (n = 8), were identified. There were no deaths, conversions, or intraoperative complications. Three patients were lost to follow-up after the 3-month visit. The early (<30 d) major morbidity rate was 10.0%. At a median follow-up of 37 (range, 6-95) months, the cohort had a mean BMI of 42.3 ± 6.7 kg/m(2), which corresponded to a mean percent excess weight loss of 44.5% ± 20.5% and mean percent total weight loss of 24.4% ± 12.2%. The most percent excess weight loss was achieved after LRYGB (54.1% ± 19.4%), followed by LSG (48.3% ± 10.2%) and then LAGB (26.2% ± 14.4%). Diabetic medication reduction in number and/or dosage was observed in 40% (6/15) patients, and 33% (5/15) of patients were completely off antidiabetic agents. CONCLUSIONS Although further research is needed, the present data suggest that successful weight loss and metabolic improvement can be achieved safely in the high-risk population of super-obese elderly.
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Affiliation(s)
| | - Amin Andalib
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Derrick Cetin
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
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