Bariatric Surgery

The best results in bariatric surgery are achieved by tightly integrated teams able to provide more than just consistent high quality surgical procedures but pre and post surgical nutritional, social and emotional support to well motivated, fully informed committed patients.

Absolute contraindications – here are few for bariatric surgery:

• ASA Score 4 or above
• Pre-existing “non trivial” malignancy

Relative contraindications include:

• Significant co-morbidities unlikely to be arrested or improved by bariatric surgery
• Uncontrolled psychiatric conditions (psychosis, severe neurosis or addiction)
• Previous gastric surgery or abdominal irradiation
• Non-dietary causes of obesity (neurological e.g. prada-willi syndrome, steroid induced etc.)
• BMI less than 35

Criteria

Four major criteria (Impact on Life, Likelihood of achieving maximum benefit with respect to control of diabetes, Duration of Benefit and Surgical Risk) are used to characterise the need and potential to benefit of each particular patient for whom surgery is recommended as the best treatment option. Each of these major criteria has multiple categories to enable an accurate representation for every patient.

The prioritisation score might be determined at three points along the elective surgery chain: determination of access to FSA, at FSA to determine surgical access and after the period of ‘compliance assessment’ to re-establish surgical treatment order.