TOPLINE:

Metabolic-bariatric surgery (MBS) in patients aged 65 years or older resulted in long-term meaningful weight loss and remission of obesity-related conditions, although complication rates of about 8% were noted.

METHODOLOGY:

• Researchers in Austria conducted a retrospective cohort study to evaluate the long-term safety and efficacy of MBS in achieving weight loss and remission of obesity-related complications in patients aged 65 years or older.
• They included 111 patients (median age, 67.2 years; 64% women; mean BMI at baseline, 45.2) who underwent primary MBS — sleeve gastrectomy, Roux-en-Y gastric bypass, one-anastomosis gastric bypass, or single-anastomosis duodenoileal bypass with sleeve — between 2008 and 2025.
• Demographic variables and weight measures were assessed at baseline, and weight, BMI, total weight loss (TWL), and excess weight loss were assessed at 1, 2, and 5 years of follow-up.
• Obesity-related complications including type 2 diabetes (T2D), arterial hypertension (aHTN), hyperlipidaemia, and obstructive sleep apnoea syndrome (OSAS) were evaluated. Remission was defined as stopping all medications for each specific obesity-related complication.
• Mortality and Clavien-Dindo complications of grade 3b and above requiring endoscopic or surgical interventions under general anaesthesia were recorded; complications were categorised as early complications (occurring within the first 30 days after surgery) and mid-term complications (from 1 month to 5 years).

TAKEAWAY:

• The mean body weight reduced from 125.8 kg at baseline to 91.0 kg at 1 year, 84.0 kg at 2 years, and 77.9 kg at 5 years, corresponding to a mean BMI reduction from 45.2 to 32.8, 30.4, and 27.5, respectively.
• Among the different procedures, the highest mean TWL at 5 years (43.8%) and the lowest mean BMI at 5 years (26.78) were noted for single-anastomosis duodenoileal bypass with sleeve.
• From baseline to 5 years post-MBS, the prevalence of T2D, aHTN, hyperlipidaemia, and OSAS decreased from 54.1% to 22.9%, 87.4% to 56.2%, 55.0% to 25.0%, and 17.1% to 4.2%, respectively.
• Overall, 7.2% of patients experienced each early and mid-term complications, with reoperation due to complications required in 9.0% of patients. Among 10.8% of deaths reported, none were related to MBS.

IN PRACTICE:

"Although complication rates tend to be relatively high, the overall benefit-risk ratio supports using MBS for appropriately selected individuals ≥ 65 years without severe medical conditions that would increase perioperative risk," the authors wrote.

SOURCE:

This study was led by Lea Pedarnig, Department of General Surgery, Medical University of Vienna, Vienna, Austria. It was published online on May 22, 2026, in Obesity Surgery.

LIMITATIONS:

The lack of follow-up gastroscopies led to an incomplete assessment of effects of gastro-oesophageal reflux disease in older adult patients. The small sample size precluded the direct comparison of efficacy between the different surgical procedures. Data on perioperative risk profiles — including American Society of Anesthesiologists score, frailty assessment, and Charlson Comorbidity Index — were lacking for the majority of patients.

DISCLOSURES:

Open access funding was provided by the Medical University of Vienna. One author declared receiving educational grants from Medtronic and Johnson & Johnson and speaker fees from Medtronic and Olympus.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.