Lap Gastric Banding for Older People - Is it Safe Over 60?

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Recent statistics show that 35% of people in the US are obese, a number that was much lower 10 years ago. Other countries are wrestling with growing obesity, as well. The  obesity percentage in Australia is 20%, in the UK 20% and in China around 8%. Experts predict that these numbers are likely to increase.

While lap band weight loss surgery has long been proven to be the best treatment option for selected patients, it is still debatable if it is beneficial for older people.

Surgery may put this special category of people at risk since dramatic weight loss has been linked to significant lessening of muscle mass and demineralization of bones, rendering older patients susceptible to hip fractures.

Is Weight Loss Beneficial for Older People?

It is undoubted that overweight elderly face difficulty as they perform basic daily activities, such as going up the stairs, bending over to pick up something, engaging in common hygiene activities, etc. Moreover, obesity, being a risk factor for joint disease, hastens the occurrence of arthritis, which affects mobility of older people.

Can Laparoscopic Band Surgery Improve Quality of Life In Older People?

Studies show that selected obese young people can greatly benefit from Laparoscopic Gastric Banding (LGB) Surgery. Can LGB bring about similar improvements in elderly patients?

A May 2010 study examined the hospital records of 113 patients over 60 that received the Lap Band System or the Swedish Adjustable Gastric Band (Ethicon Endo-Surgery) between 1999 and 2008, under a single surgeon.

Patients were followed up 2-5 years after surgery. A Quality of Life questionnaire was given to them in order to evaluate the success of the operation. The patients participated in the survey by documenting the changes that the surgery brought about in their life in terms of weight, medications, and overall quality of life.

Were There Any Complications?

None of them died, at least not during the follow up period, except for 3 patients who passed away due to cancer. Patients stayed in the hospital for an average of 2 days after the surgery. Ten patients had to stay for at least 1 day in intensive care unit.

Minor complications appeared in 24 people and included mainly port infections. Major complications included slipped band in two cases, and gastric obstruction in two other cases. Except for one patient who suffered from pneumonia and had his band removed, all other major complications were resolved by successful re-operation.

Finally, five patients had their bands removed due to band intolerance.

How Much Weight Did They Lose?

Patients lost on average 23.3 kg (51.3 lb). The weight loss was measured as excess BMI loss. BMI (Body Mass Index) is a measure of obesity based on one’s weight and height. The higher the BMI the more obese a person is likely to be. At 1 year, BMI was reduced 43.3% and stayed at that level without significant change until the 6 year follow up mark.

Did The Quality of Life Improve?

Patients scored high in all 8 sections of the Quality of Life questionnaire. A marked improvement was noticed in physical function. In fact, physical functioning reached the levels observed in normal people of same age.

Social functioning improved as well, while mental and emotional health increased above normal.

Half of the band patients saw improvement in self-esteem. In more than one third of the patients depression symptoms decreased. Specifically, 4% of the band patients became anti-depressant free.

More than 90% of the patients said they would recommend the band to other obese people over 60.

Did Obesity Co-morbidities Change?

Diabetes improved in 75% of the cases. Hypertension, sleep apnea and hyperlipidaemia improved in more than 50% of the patients.

Did The Medication Change?

Except for the diabetics, 44% of whom reported using less diabetic medication, no substantial decrease in pharmacotherapy was observed as a result of the lap band surgery. Patients maintained the pre-operation levels of medication.

In conclusion

Despite the high levels of co-morbidities in older people, medical complications after lap band surgery were infrequent— less than 5%. This contrasts with the effect of Roux-en-Y Gastric Bypass in the elderly, which has been shown to be more risky. Studies have shown that major complications can appear in as much as 15% of the patients and mortality up to 4.8% in elder gastric bypass patients

This study showed that morbidly obese people over 60s will potentially see great improvements in quality of life with laparoscopic gastric banding. However, medication reduction is unlikely to occur.

As investigator Anthony Clough notes,

"We believe that laparoscopic gastric banding is the most appropriate bariatric procedure for this age group due to its inherent safety and proven efficacy."

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