Current evidence suggests that bariatric surgery offers the best hope for substantial and sustainable weight loss in patients with morbid obesity. These facts, coupled with the improved minimally invasive procedures, have driven a four-fold increase in the number of bariatric operations performed over recent years in the UK.
Bariatric surgery though is not suitable for everyone. A BMI>59, Age>50, smoking, sleep apnoea and CVD disease all increase the risk of death and complications. Weight loss is often suboptimal in patients who have significant psychiatric disease, those who are less well informed, or not motivated.
Pre-operative evaluation and education of patients ensures that expected benefits of the operation outweigh the risks. This involves determining a patients indication for surgery, identifying issues which may interfere with the success of surgery, and assessing and treating co-morbid diseases. Typically assessment includes psychological testing, nutrition evaluation and medical assessment.
Successful weight loss and prevention of complications post operatively require close follow-up by a multidisciplinary team. Frequent blood tests and nutritional input is needed to prevent micronutrient deficiencies and maintain good eating behaviour. For gastric bands regular fills are needed to reduce satiety but not cause undue restriction. Medical input is also needed to prevent weight regain and manage the co-morbid diseases.
This talk will provide clear guidance on how to assess, prepare and manage patients undergoing bariatric surgery.