Patient Selection and Preoperative Evaluation

Bariatric Preop: Indications - Weighing Options

Key indications for bariatric surgery:

• BMI Criteria (General):
  • BMI ≥ 40 kg/m²
  • BMI ≥ 35 kg/m² with comorbidities.
• Asian/Indian Guidelines (OSSI):
  • BMI ≥ 37.5 kg/m² (Morbid Obesity).
  • BMI ≥ 32.5 kg/m² with ≥1 comorbidity (e.g., T2DM, HTN, OSA).

  ⭐ Consider for BMI ≥ 27.5 kg/m² with uncontrolled T2DM & central obesity.

• Other Factors:
  • Age 18-65 years (case-by-case).
  • Failure of conservative weight loss attempts.
  • Acceptable operative risk.
  • Psychologically stable & motivated patient.

Bariatric Preop: Contraindications - Red Flags Ahead

• Absolute:
  • Uncontrolled severe psychiatric illness (e.g., psychosis, severe depression)
  • Active drug/alcohol abuse 📌 (SUD: Stop Until Detoxed)
  • Reversible endocrine obesity causes (e.g., untreated Cushing's, hypothyroidism)
  • Inability to comprehend or comply with lifelong dietary/follow-up needs
  • Active cancer (not in remission)
  • Current pregnancy or planned pregnancy within 12-18 months post-op
  • Prohibitive anaesthetic risk (e.g., severe cardiorespiratory disease, ASA > IV)
• Relative:
  • Severe coagulopathy
  • Significant portal hypertension with varices
  • Advanced age (evaluated on a case-by-case basis)
  • Limited life expectancy from other diseases
  • Stable but significant psychiatric conditions (e.g., managed depression, eating disorders)
  • Lack of adequate social support system

⭐ Active substance abuse (drug or alcohol) is a critical absolute contraindication for bariatric surgery due to risks of non-compliance, malnutrition, and surgical complications.

Bariatric Preop: Essential Workup - Pre-Flight Checks

• Eligibility: BMI ≥ 40 kg/m² OR BMI ≥ 35 kg/m² with significant comorbidities (T2DM, HTN, OSA, severe joint disease).
• Multidisciplinary Evaluation: Essential.
  • Medical Assessment:
    • Detailed H&P: Focus on obesity-related diseases.
    • Cardiovascular: ECG (all); Echo/Stress test if indicated.
    • Pulmonary: PFTs, Polysomnography if OSA suspected/confirmed. CPAP for OSA.
    • GI: Upper GI Endoscopy (EGD) mandatory - check for H. pylori, hiatus hernia, ulcers.
    • Endocrine/Labs: HbA1c, TSH, lipid profile, Vit D, B12, folate, iron panel, LFTs, RFTs.
  • Nutritional Assessment:
    • Identify deficiencies (e.g., iron, Vit D, B12).
    • Counsel on post-op diet.
  • Psychological Evaluation:
    • Assess motivation, realistic expectations, adherence potential.
    • Screen for eating disorders (binge eating), active substance abuse, uncontrolled psychiatric illness.
• Pre-operative Optimization:
  • Smoking cessation: ≥ 6-8 weeks prior.
  • Optimize glycemic control (HbA1c < 7-8%).
  • VTE prophylaxis initiated.
• Informed Consent: Detailed discussion of risks/benefits.

⭐ Routine pre-operative Upper GI Endoscopy (EGD) is crucial to identify pathology like large hiatal hernias or H. pylori infection that may require treatment or alter the surgical approach.

Bariatric Preop: MDT & Consent - Team Huddle

• MDT Approach Essential:
  • Core Team: Surgeon, Physician (e.g., Endocrinologist), Dietitian, Psychologist.
  • Anaesthetist for perioperative care.
  • Aims: Comprehensive assessment, optimize co-morbidities, patient education, shared decision-making.
• Informed Consent Process:
  • Detailed discussion: Procedure types, benefits, risks (early/late), alternatives, expected outcomes, lifelong commitment.
  • Ensure patient comprehension.
  • Formal documentation vital.

⭐ MDT evaluation is crucial; lack of social support or severe, uncontrolled psychiatric conditions are key relative contraindications.

High‑Yield Points - ⚡ Biggest Takeaways

• BMI ≥ 40 or BMI ≥ 35 with comorbidities (T2DM, HTN, OSA) are primary indications.
• Mandatory MDT evaluation: surgical, medical, nutritional, psychological.
• Contraindications: Uncontrolled psychiatric illness, active substance abuse, non-compliance.
• Pre-op nutritional screening (iron, B12, Vit D) & optimization is vital.
• Informed consent covers risks, benefits, and lifelong lifestyle changes.
• Smoking cessation (≥6-8 weeks pre-op) and failed non-surgical attempts are key_selection_criteria_and_preoperative_evaluation_for_bariatric_surgery_in_neet_pg_preparation