There are certain contraindications for bariatric procedures, i.e. in these cases, it is recommended not to perform the procedures. These include among others:
- untreated eating disorders such as bulimia
- substance addictions (alcohol, drugs, medication)
- threatening underlying diseases
- malign diseases
- untreated diseases of hormone-producing organs
- pregnancy or soon planned pregnancy
In principle, there is no contraindication to perform bariatric surgery on patients at an advanced age (> 65 years). Older patients also benefit from the positive effects of obesity or metabolic surgery, although the extent of weight loss at this stage of life may be less than at a younger age. The positive effects regarding diabetes mellitus type 2, high blood pressure, sleep apnoea syndrome and lipometabolic disorders are comparable with the results of younger patients. Patients of older age also benefit from an improved quality of life, mobility and a delay in the need for long-term care.
In the case of exhausted or hopeless conservative therapy, obesity or metabolic surgery can be considered at an advanced age from a BMI > 40 kg/m² or > 35 kg/m² with significant obesity-related concomitant diseases. In these cases, however, the indication for surgery is an individual decision on a case-by-case basis. The rate of intra- and postoperative complications in older patients undergoing bariatric surgery is only slightly higher than in younger patients.
Bilbiography sources:
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Bianco P, Rizzuto A, Velotti N, Bocchetti A, Manzolillo D, Maietta P, Milone M, Amato M, Conzo G, Buonomo O, Petrella G, Musella M. Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow up at three years. Minerva Chir. 2018 Jun 29.
Chouillard E, Alsabah S, Chahine E, Saikaly E, Debs T, Kassir R. Changing the quality of life in old age bariatric patients. Cross-sectional study for 79 old age patients. Int J Surg. 2018 Jun;54(Pt A):236-241.
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Giordano, S.; Victorzon, M. (2015): Bariatric surgery in elderly patients: A systematic review 10, S. 1627–1635.
Hassinger TE, Mehaffey JH, Johnston LE, Hawkins RB, Schirmer BD, Hallowell PT. Roux-en-Y gastric bypass is safe in elderly patients: a propensity-score matched analysis. Surg Obes Relat Dis. 2018 Apr 17. pii: S1550-7289(18)30172-2
Janik MR, Mustafa RR, Rogula TG, Alhaj Saleh A, Abbas M, Khaitan L. Safety of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in elderly patients - analysis of the MBSAQIP. Surg Obes Relat Dis. 2018 Apr 23. pii: S1550-7289(18)30214-4
Kaplan U, Penner S, Farrokhyar F, Andruszkiewicz N, Breau R, Gmora S, Hong D, Anvari M. Bariatric Surgery in the Elderly Is Associated with Similar Surgical Risks and Significant Long-Term Health Benefits. Obes Surg. 2018 Aug;28(8):2165-2170
Lynch, J.; Belgaumkar, A. (2012): Bariatric surgery is effective and safe in patients over 55: A systematic review and meta-analysis. In: Obesity surgery 22, S. 1507–1516.
Mohun SH, Spitznagel MB, Gunstad J, Rochette A, Heinberg LJ. Performance on the Montreal Cognitive Assessment (MoCA) in Older Adults Presenting for Bariatric Surgery. Obes Surg. 2018 Jun 5.
O'Brien R, Johnson E, Haneuse S, Coleman KJ, O'Connor PJ, Fisher DP, Sidney S, Bogart A, Theis MK, Anau J, Schroeder EB, Arterburn D. Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study. Ann Intern Med. 2018 Aug 7.
