Revisional bariatric surgery in the elderly: a comprehensive review of the safety and efficacy profile.

Abstract

Background: Despite the well-known safety and efficacy of metabolic and bariatric surgery, certain patients require revisional bariatric surgery (RBS) due to weight-related and/or procedure-related complications. Date on long-term RBS outcomes remains limited in the elderly.

Objectives: To evaluate the safety and efficacy of RBS in the elderly.

Setting: Tertiary referral centers with prospectively maintained metabolic and bariatric surgery databases.

Methods: A retrospective review was conducted for patients aged ≥ 60 years who underwent RBS between 2008 and 2023. Patient demographics, type of revisional procedure, postoperative outcomes, weight loss data, and nutritional parameters were collected. All patients had at least a 6-month follow-up and were followed at least 5 years after RBS when possible.

Results: 201 patients were included. The most common indication for RBS was gastroesophageal reflux (37.8%). Conversion to Roux-en-Y gastric bypass was the most common RBS procedure (65.2%). This subgroup achieved significantly sustained mean percentage of total weight loss throughout follow-up. Conversion to sleeve gastrectomy subgroup only maintained a significant mean percentage of total weight loss at 6 months, 1 year, and 2 years postoperatively. The overall 30-day and late complication rates within the cohort were 17.4% and 26.9%, respectively. A .5% 30-day mortality rate and 0% long-term RBS-related morality rate were reported. For patients indicated for revision, RBS was successful in resolving malnutrition and did not result in recurrence of any nutritional deficiencies.

Conclusions: Our study demonstrated that RBS is safe and effective in elderly patients in the long term. Proper RBS procedure selection is integral to address revision indication and decrease the risk of long-term complications.