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The Best Laparoscopic Bariatric Operation for Older Patients: Comparison of Outcome After the Band, Vertical Gastrectomy (VG), Roux-en-Y Gastric Bypass (RGB), and Duodenal Switch (DS) Operations
Crystine M. Lee, Janos Taller, John J. Feng, Paul T. Cirangle, Gregg H. Jossart, California Pacific Medical Center, San Francisco, CA

Bariatric operations differ in mechanism of action, efficacy, and complication profile. Age-related differences in outcome after operations are not well characterized. This study attempts to determine which of the bariatric operations results in superior outcome for older patients.

METHODS:
A retrospective comparison of patients over 50 years of age undergoing 4 bariatric operations was performed. The Lap-Band® is placed around the proximal stomach, creating a 20cc pouch. VG is a stapled, greater curvature gastrectomy resulting in a restrictive gastric tube. The RGB is performed with an antecolic Roux limb, and a hand-sewn gastroenterostomy to a 20cc linear gastric pouch. The DS is performed with a 100cm common channel, and a hand-sewn duodenoenterostomy.

RESULTS:
Between 11/02-11/04, 634 primary laparoscopic bariatric operations were performed at our center and of these, 166 (26%) operations on patients > 50 years. Of these, 37 (22%) were BAND, 32 (19%) were VG, 84 (51%) were RGB, and 13 (8%) were DS. OR time was shortest for BAND and VG (95±21mins, 102±33mins), versus RGB and DS (140±33mins, 221±36mins)(P<0.05). There were no conversions to open and no deaths.

CONCLUSION:
These data suggest that the best bariatric operation for patients older than 50 years of age may be the VG because it achieves the greatest weight loss with the shortest operative time and fewer complications.


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