Safety and efficacy of laparoscopic adjustable gastric banding in the elderly

Bariatric surgery is not usually recommended in the elderly. The aim of this study is to evaluate the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in older patients registered in the database of the Italian Group for Lap-Band Gruppo Italiano Lap-Band (GILB).

GILB is a centralized database which collects operative and follow-up data from 26 Italian surgical centers who utilize the Lap-Band System as a restrictive procedure. Patients > or =60 years were selected from the database of the GILB and analyzed according to co-morbidities, conversion, peri-operative complications, and weight loss.

Of 5,290 patients, 216 (4.1%; 184F/32M) were > or =60 years old at surgery (mean age 64.1 +/- 4.0 years; range 60-83). Baseline BMI was similar in both sets of patients i.e., > or =60 and <60 years of age (44.2 +/- 7.6 kg/m(2) vs. 44.9 +/- 7.4 kg/m(2)). Patients > or =60 years of age were more frequently affected by co-morbidities than patients <60 years of age. Two cases of operative mortality were observed in patients <60 years old (0.04%) and one in patients > or =60 years old (0.46%). The proportion of patients requiring revision surgery was comparable as well. Weight loss was significantly lower in elderly patients. Despite their lower weight loss, patients > or =60 years of age experienced a significant improvement of obesity-related co-morbidities (they showed improvement 1 year after surgery in 100% of cases of diabetes or sleep apnoea, 67.1% of cases of hypertension, and 34.9% of cases of osteoarthritis).

LAGB may be performed safely in patients > or =60 years old. Weight loss in older patients seems unsatisfactory if compared to younger subjects. However, the majority of elderly patients show an improvement in obesity-related co-morbidities.