Bariatric Surgery: Selection & Pre-Operative Work Up

  • Criteria for selection of appropriate candidates for bar­iatric surgery have been established to minimize surgical complications and to maximize the benefit of these important and limited procedures.
  • The preoperative workup should evaluate a patient’s medical, nutritional, mental and functional health status.
  • Special attention should be given to the care of patients living with type 2 diabetes (T2DM) who are considering bariatric surgery to minimize complications from uncon­trolled diabetes in the perioperative period.
  • Because of the risks of postoperative complications associated with tobacco use, cessation prior to bariatric surgery is mandatory and should be maintained lifelong.
  • In patients living with severe obesity, bariatric surgery, in combination with behavioral interventions, is a more effective option for long-term weight loss and control of chronic conditions, such as T2DM, hypertension, sleep apnea and dyslipidemia, as well as other conditions associated with increased adiposity.
  • We suggest a comprehensive medical and nutritional evaluation be completed and nutrient deficiencies corrected in candidates for bariatric surgery (Level 4, Grade D).
  • Preoperative smoking cessation can minimize postoperative complications (Level 2a, Grade B).
  • We suggest screening for and treatment of obstructive sleep apnea in people seeking bariatric surgery (Level 4, Grade D).
  • Bariatric surgery is the beginning of a life-long journey. You should educate yourself about the necessary changes required to optimize your long-term outcomes for a healthier life.
  • Before surgery you will be asked to perform several investi­gations such as blood work, cardiac or pulmonary testing, to ensure that you are ready and safe for surgery.
  • If you are at high risk for obstructive sleep apnea, you may be asked to undergo a sleep study to determine if you have significant sleep apnea.
  • A current or recent history of smoking or nicotine con­sumption puts you at risk of complications after bariatric surgery. Smoking is cessation is required before surgery, and must be maintained for life.
  • You may be given a low-calorie diet two to three weeks before surgery in order to shrink your liver size and make your surgery easier.
  • If you are living with diabetes, you will have to follow your blood sugars very closely and obtain instructions on how to adjust your diabetes medications while on the low-calorie diet prior to bariatric surgery.
  • Because changes in the absorption of some medications may occur with certain bariatric surgical procedures, you may be asked to change either the type or preparation of the medication you are currently taking.

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