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Preoperative Management of Candidates for Bariatric Surgery

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The Perfect Sleeve Gastrectomy

Abstract

Obesity is a chronic and complex disease. Bariatric surgery is a link in the chronic and continuous care of obesity.

Therefore, the preparation for a bariatric surgery is not only the common preoperative preparation for any other major abdominal surgery. It should include not only the optimizing treatment of comorbidities to reduce the risks of the surgical procedure but also ensuring the patient is fully informed about the necessity of lifelong follow-up, the acceptance of lifestyle modification including behavioral changes, and follow-up compliance.

The value of care pathways is well recognized in bariatric surgery. Current literature does support the value of clinical care pathways in bariatric surgery, since that publications show that their implementation reduces cost and decreases hospital length of stay and perioperative complications.

A decision to offer surgery should follow a comprehensive interdisciplinary assessment. The core team providing such assessment should optimally consist of specialists, experienced in obesity management and bariatric surgery: physicians, surgeons, anesthetists, psychologists or psychiatrists, nutritionists, nurses, etc. An individual assessment completed by an experienced multidisciplinary team is essential to ensure that candidates are suitable for surgery. This evaluation should include a thorough medical assessment, as well as psychological and dietetic assessments.

Patients with obesity have a high prevalence of micronutrient deficiencies compared with healthy weight individuals of the same sex and age. Optimizing postoperative patient outcomes and nutritional status begins preoperatively.

A multidisciplinary preparation should be offered to the individual as the next essential step in the bariatric surgery as a treatment. Presurgical weight loss could have an impact on surgical risk, postoperative morbidity, surgery time, conversion rate to open surgery, and the number of postoperative transfusions. It also helps to achieve glycemic goals in patients with diabetes. Preoperative weight loss should be indicated, although the most appropriate amount of weight loss, duration, and diet is still a matter of controversy and is left to the treating physician’s consideration.

A dynamic and evidence-based clinical pathway would provide a valuable resource for existing programs, which will positively affect the care of our patients.

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Author information

Authors and Affiliations

  1. Nutrition and Diabetes of CIEN (Center of Obesity, Diabetes and Bariatric Surgery), Corrientes, Buenos Aires, Misiones and Formosa, Argentina

    Marianela Aguirre Ackermann

  2. Universidad Nacional del Nordeste, Corrientes, Argentina

    Marianela Aguirre Ackermann

  3. Bariatric Surgery and Mini-invasive Surgery of CIEN (Center of Obesity, Diabetes and Bariatric Surgery), Corrientes, Buenos Aires, Misiones and Formosa, Argentina

    Edgardo Emilio Serra

  4. CIEN-Diagnomed Center (Center of Obesity, Diabetes and Bariatric Surgery), Buenos Aires, Argentina

    Guillermo Emilio Duza

  5. University of Buenos Aires (UBA), Buenos Aires, Argentina

    Guillermo Emilio Duza

Authors
  1. Marianela Aguirre Ackermann
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  2. Edgardo Emilio Serra
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  3. Guillermo Emilio Duza
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Editor information

Editors and Affiliations

  1. Department of Surgery, Sacré-Coeur Hospital, Montréal, QC, Canada

    Michel Gagner

  2. Bariatric Surgery, Gastro Obeso Center, Sao Paulo, Brazil

    Almino Ramos Cardoso

  3. Diagnomed, University of Buenos Aires, Buenos Aires, Argentina

    Mariano Palermo

  4. Emirates Specialty Hospital, Dubai, United Arab Emirates

    Patrick Noel

  5. CHU Montpellier, Saint Gely du Fesc, France

    David Nocca

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Ackermann, M.A., Serra, E.E., Duza, G.E. (2020). Preoperative Management of Candidates for Bariatric Surgery. In: Gagner, M., Cardoso, A., Palermo, M., Noel, P., Nocca, D. (eds) The Perfect Sleeve Gastrectomy. Springer, Cham. https://doi.org/10.1007/978-3-030-28936-2_4

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