Outcomes of Revisional Restrictive Bariatric Surgery in Older Adults: Five-Year Follow-Up

Overview

This study evaluated 40 patients aged ≥65 undergoing revisional bariatric surgery (RBS) after previous restrictive procedures due to insufficient weight loss or weight regain. The analysis compared outcomes between patients with prior laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG), focusing on safety, weight loss, and resolution of comorbidities over a mid-term follow-up.

Background

Metabolic and bariatric surgery (MBS) is effective for severe obesity, leading to sustained weight loss and improvement in related conditions such as type 2 diabetes and hypertension. Revisional bariatric surgery (RBS) accounts for 9–18% of all MBS, often indicated for weight regain or insufficient weight loss, especially after restrictive procedures. The safety and efficacy of RBS in elderly patients remain under investigation, with recent guidelines supporting surgery without strict age limits but recommending additional assessments. This study addresses outcomes of RBS in patients aged 65 and older following prior restrictive bariatric procedures.

Data Highlights

Key Findings

• Forty patients aged ≥65 underwent RBS due to insufficient weight loss or weight regain after prior restrictive procedures.
• 23 patients had previous laparoscopic adjustable gastric banding (LAGB), and 16 had prior sleeve gastrectomy (SG).
• Revisional procedures included one anastomosis gastric bypass (OAGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB), all performed laparoscopically.
• Perioperative outcomes included monitoring for complications graded by Clavien–Dindo system, with data collected on leaks, bleeding, obstruction, and reoperations.
• Mid-term follow-up showed total weight loss and remission of comorbidities such as type 2 diabetes, hypertension, and hyperlipidemia according to established clinical criteria.

Clinical Implications

Revisional bariatric surgery in older adults following prior restrictive procedures appears feasible and can lead to meaningful weight loss and improvement in obesity-related comorbidities. Careful multidisciplinary evaluation and adherence to surgical guidelines are essential to optimize outcomes and minimize perioperative risks in this population.

Conclusion

RBS in patients aged 65 and older after restrictive bariatric procedures is a safe and effective option for addressing insufficient weight loss or weight regain, with favorable mid-term outcomes in weight reduction and comorbidity resolution.

References

1. Metabolic and Bariatric Surgery Guidelines and Outcomes, 2022
2. Clavien–Dindo Classification of Surgical Complications, 2004
3. Recent Studies on Bariatric Surgery in Elderly Patients, 2010-2022