Laparoscopic Sleeve Gastrectomy Is Safe for Patients Over 60 Years of Age: A Meta-Analysis of Comparative Studies.

Abstract

Background and Aims: Laparoscopic sleeve gastrectomy (LSG) among older obese subjects (>60 years of age) has recently gained popularity because of the population aging. We performed a meta-analysis to clarify whether elderly patients undergoing this procedure have an increased complications risk. Methods: A literature search aiming at outcomes of LSG in elderly patients throughout Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases was performed from inception until June 2019. Primary endpoints consisted of mortality and overall complications. Secondary endpoints comprised excess weight loss percentage (%EWL), remission, or postoperative improvement of several comorbidities (type-2 diabetes [T2DM], hypertension, dyslipidemia, and obstructive sleep apnea [OSA]). Heterogeneity between the studies was assessed by I2 test and random effects model for the comparative analysis. Mean difference (MD) and relative risk (RR) were used to report the results. Results: Eleven studies involving 2259 patients were scrutinized for this study. Overall complications rates did not significantly differ among younger and elderly patients undergoing LSG (RR: 1.71; 95% CI [confidence interval]: 0.76-3.83; P = .19). %EWL was superior among younger patients (MD: -7.63; 95% CI: -13.19 - 2.08; P = .007) while there were no significant differences in remission of T2DM, hypertension, and hyperlipidemia between the age groups (RR: 1.04; 95% CI: 0.83-1.31; P = .72; RR: 1.00; 95% CI: 0.84-1.18; P = .96; RR: 1.05; 95% CI: 0.79-1.38; P = .76). Younger patients exhibited a significantly higher OSA remission/improvement rate (RR: 0.81; 95% CI: 0.69-0.95; P = .001). Conclusion: LSG is a reliable bariatric method that is also safe in elderly patients with similar overall morbidity and similar obesity-related comorbidity resolution rates than younger ones, although weight loss outcomes were inferior.