Six conditions are required to benefit from bariatric surgery:

  • BMI ≥ 40 kg/mOR BMI ≥ 30 to 40 kg/m2
    with at least one comorbidity that is likely to improve following surgery (high blood pressure, obstructive sleep apnoea syndrome, type 2 diabetes, incapacitating joint disorders, non-alcoholic steatohepatitis, etc.)
  • failure of medical, nutritional, dietetic and psychotherapeutic treatment that has been properly conducted for six to 12 months (weight loss is not sufficient or weight loss is not maintained)
  • multidisciplinary preoperative assessment and management for several months
  • patient is well informed
  • patient has understood and accepted the need for lifelong surgical and medical follow-up
  • acceptable operating risk.

Contraindications, some of which may be temporary:

  • severe cognitive or mental disorders
  • severe and non-stabilised eating disorders
  • alcohol or psychoactive substances dependence
  • diseases that are life-threatening in the short and medium term
  • contraindications to general anaesthesia
  • absence of identified prior medical management of obesity and likely inability of the patient to participate in lifelong medical follow-up

Preoperative medical, psychological and educational management for several months is necessary:

  • assessment and management of comorbidities (high blood pressure, obstructive sleep apnoea syndrome, type 2 diabetes, incapacitating joint disorders, non-alcoholic steatohepatitis, etc.), assessment of eating behaviour and management of any eating disorder, nutritional and vitamin assessment and correction of any deficits, upper gastrointestinal endoscopy with tests for Helicobacter pylori
  • psychological/psychiatric assessment: for all patients who are candidates for obesity surgery
  • therapeutic education programme : diet and physical exercise.

Deciding to Operate

A decision is made following multidisciplinary medical and surgical discussion and consensus that may involve the general practitioner.

Decision_to_operate

 

Surgical Techniques →

Surgery can dramatically improve quality of life and improve medical conditions associated with obesity.

Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery
New England Journal of Medicine 2009;361:445-54.
Quality of Life Outcomes of Bariatric Surgery: A Systematic Review.
Obesity Surgery2016 Feb; 26(2): 395-409