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This study compares laparoscopic sleeve gastrectomy (a type of weight-loss surgery) with non-surgical care in adults aged 65 or older who have severe obesity and related health problems like type 2 diabetes, high blood pressure, knee joint issues from osteoarthritis, or sleep apnea. Over 12 months, 60 patients chose either surgery or diet counseling with medications for their conditions (30 in each group). The main goals are to measure improvements in these health issues, weight loss, and safety.
Why This Study Matters Severe obesity in older adults raises risks for serious health conditions that diet and medications often fail to fix long-term. Surgery like sleeve gastrectomy removes part of the stomach to limit food intake and improve hormones that control hunger and blood sugar, but its benefits need direct proof against usual care in seniors.
What Happens in the Study Patients picked their treatment: surgery group got the procedure plus routine care; non-surgery group got nutrition advice and standard drugs. Doctors tracked weight, blood tests, blood pressure, sleep studies, knee X-rays, drug needs, and side effects at 1, 3, 6, and 12 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Laparoscopic Sleeve Gastrectomy (LSG) | Experimental | Patients aged ≥65 years with BMI ≥40 kg/m² and ≥1 weight-related comorbidity underwent laparoscopic sleeve gastrectomy (LSG) under general anesthesia using the baseball diamond trocar technique, 34-Fr bougie calibration, and linear stapling from 4-6 cm proximal to the pylorus to the angle of His. Standard perioperative care included VTE prophylaxis (enoxaparin 40 mg SC daily ×10 days, sequential compression devices) and methylene blue leak test. Follow-up at 1, 3, 6, and 12 months assessed weight loss, comorbidities, medication use, quality of life, and complications (Clavien-Dindo graded). |
|
| Conservative Management | Active Comparator | Patients aged ≥65 years with BMI ≥40 kg/m² and ≥1 weight-related comorbidity received structured dietary counseling (500-800 kcal deficit by certified nutritionists) plus guideline-directed pharmacotherapy for comorbidities (T2D, HTN, OSA, osteoarthritis) in specialized clinics. No anti-obesity medications (e.g., GLP-1 agonists) were used due to patient refusal related to high cost and lack of insurance coverage. Follow-up at 1, 3, 6, and 12 months assessed weight, comorbidities, medication use, quality of life, and safety. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Laparoscopic Sleeve Gastrectomy (LSG) | Procedure | Laparoscopic sleeve gastrectomy performed under general anesthesia using 5 trocars (baseball diamond technique), liver retraction (Nathanson), Ligasure dissection of greater curvature/short gastrics, 34-French bougie calibration along lesser curvature, sequential linear stapling (60-mm, 4-5 firings) from 4-6 cm proximal to pylorus to angle of His, staple line reinforcement optional, resected stomach removed via port, methylene blue leak test, and routine VTE prophylaxis (enoxaparin 40 mg SC daily ×10 days + sequential compression devices). |
| Measure | Description | Time Frame |
|---|---|---|
| Change in weight-related comorbidity status at 12 months | Proportion of patients with change in comorbidity status at 12 months, including percentage requiring medication for each comorbidity (type 2 diabetes mellitus, hypertension, obstructive sleep apnea, osteoarthritis), medication dose change or discontinuation, and complete resolution of each condition. | Baseline to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in body mass index | Change in BMI (kg/m²) = 12-month BMI - baseline BMI | Baseline to 12 months |
| Change in HbA1c | Change in HbA1c (%) in patients with type 2 diabetes mellitus |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kafrelsheikh University | Kafr ash Shaykh | Egypt |
Data are available upon reasonable request from the corresponding author (khaled.elsayed1495@alexmed.edu.eg), as stated in the manuscript.
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Two parallel groups: Group A (n=30) underwent laparoscopic sleeve gastrectomy (LSG); Group B (n=30) received conservative management (dietary counseling + guideline-directed pharmacotherapy for comorbidities, no anti-obesity medications). Allocation by patient preference, prospective 12-month follow-up.
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|
| Structured Dietary Counseling | Behavioral | Structured dietary counseling providing a 500-800 kcal daily deficit, delivered by certified nutritionists, combined with guideline-directed pharmacotherapy for weight-related comorbidities (type 2 diabetes, hypertension, osteoarthritis, obstructive sleep apnea) in specialized clinics. No anti-obesity pharmacotherapy (e.g., GLP-1 receptor agonists) due to high cost and lack of insurance coverage, per patient preference |
|
| Baseline to 12 months |
| Change in systolic blood pressure | Change in systolic blood pressure (mmHg) in patients with hypertension | Baseline to 12 months |
| Change in apnea-hypopnea index | Change in AHI (events/hour) by polysomnography in patients with obstructive sleep apnea | Baseline to 12 months |
| Change in knee joint space width | Change in minimum knee joint space width (mm) on standing AP radiographs in patients with osteoarthritis | Baseline to 12 months |
| Incidence of postoperative complications | Incidence and Clavien-Dindo grade of complications in LSG arm | Baseline to 12 months |
| ID | Term |
|---|---|
| D009765 | Obesity |
| D050177 | Overweight |
| D020181 | Sleep Apnea, Obstructive |
| D006973 | Hypertension |
| D003924 | Diabetes Mellitus, Type 2 |
| D010003 | Osteoarthritis |
| ID | Term |
|---|---|
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012891 | Sleep Apnea Syndromes |
| D001049 | Apnea |
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
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