Evaluating Bariatric Surgery in Patients Aged 60 Years and Older: A Retrospective Multicenter Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

Abstract

Background:

This study aimed to compare the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) in patients aged 60 and older, focusing on postoperative weight loss, improvement in obesity-related comorbidities, and perioperative outcomes.

Methods:

This was a retrospective analysis of data from three bariatric surgery centers with surgeries performed between January 2019 and September 2024. The study included patients aged ≥60 years who underwent either LSG or RYGB. The primary outcome was the comparison of weight loss metrics (excess weight loss [%EWL] and total weight loss [%TWL]) between LSG and RYGB. Secondary outcomes included the remission or improvement of type 2 diabetes mellitus (T2DM) and hypertension (HTN), 30-day postoperative complications, operative time, and length of hospital stay.

Results:

A total of 168 patients aged ≥60 who underwent LSG (n = 130) or RYGB (n = 38) were included. Both procedures resulted in similar weight loss outcomes, with a median %EWL of 58.6% for LSG and 61.2% for RYGB. The median %TWL was 23.1% for LSG and 26% for RYGB, with no significant differences between the groups (P = .275). The operative time was significantly shorter for LSG (60 minutes versus 110 minutes for RYGB, P < .001), and LSG patients had a shorter hospital stay (2 versus 3 days, P < .001). The 30-day complication rate was low for both groups, with no significant difference in complications between LSG and RYGB. Regarding comorbidity resolution, 90.7% of patients with T2DM and 93.6% with HTN experienced improvement or remission. Complete remission was achieved in 39% of all T2DM cases (37.5% in LSG, 42.9% in RYGB) and in 33% of all HTN cases (33.3% in LSG, 31.6% in RYGB), with no statistically significant differences between the groups.

Conclusions:

Bariatric surgery appears safe in older adults when guided by careful patient and procedure selection through multidisciplinary assessment. Both LSG and RYGB yielded comparable weight loss and remission outcomes for T2DM and HTN in this population.