Bariatric Surgery in the Elderly Population: A Multi-surgeon, Single-institution Retrospective Review.

Background: As the population continues to age, the number of elderly patients affected by obesity is rising. Metabolic and bariatric surgery (MBS) can benefit elderly patients seeking treatment for obesity and its related diseases. We aimed to quantify percent excess weight loss (%EWL) for elderly patients (≥ 65) undergoing MBS at a single institution and compare our results to %EWL previously reported for general and elderly populations. Additionally, we believe the safety and effectiveness of MBS is repeatable in our community setting. Methods: Laparoscopic sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass performed from November 1, 2011 - April 30, 2017 at a single institution was retrospectively reviewed. Weight loss was measured at 3, 6, and 12 month follow-up. A total of 103 patients met inclusion criteria, mean age was 67.75 years old and mean pre-operative body mass index was 45.95 kg/m2. Results: Mean %EWL was 31.9%, 43.7%, and 53.4% at 3, 6, and 12 months, respectively. %EWL at one year was not statistically different to prior reports of elderly bariatric patients (p = 0.979). While statistically lower when compared to reports in the general population, %EWL in our elderly patients was clinically similar (p < 0.001). No 30-day mortality was observed. Conclusions: Elderly patients undergoing MBS were noted to have %EWL similar to previous reports in elderly and general populations. MBS is efficacious and well tolerated in the elderly population with repeatable results. Continued reporting on the safety and efficacy is important in ensuring wider coverage and availability of these important interventions in elderly populations.

Surgical treatment of retrograde peristalsis following laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Retrograde Roux limb peristalsis following laparoscopic Roux-en-Y gastric bypass is a rare complication that can be difficult to identify. It may present as persistent nausea, vomiting, abdominal pain, or even gastrointestinal bleeding related to an anastomotic ulcer. Upper gastrointestinal (UGI) series is an important diagnostic modality to identify this motility disorder; however, it may not be readily identifiable without specific delayed imaging. The etiology of this phenomenon is unclear, but attributing factors include the presence of ectopic pacemaker cells, variable lengths of the Roux limb and misconstructions. When this problem is identified, revisional surgery is indicated. CASE DESCRIPTION: A 51-y-old female with morbid obesity presented with persistent nausea and vomiting following a laparoscopic gastric bypass. A CT scan showed a dilated Roux limb. Reverse peristalsis from the jejunojejunostomy toward the gastric pouch was identified on a UGI. Two laparoscopic revisions of the jejunojunostomy were attempted to correct this dysfunction. DISCUSSION: An attempt at widening and relaxing the anastomosis was unsuccessful at providing relief of symptoms. A second revision with an anastomosis between the Roux limb and common channel provided long-term improvement. Identifying complications of gastric bypass surgery can be challenging. Imaging studies may be limited, and often diagnostic and revisional surgery is indicated.