Guidelines for Clinical Application of Laparoscopic Bariatric Surgery


Extreme obesity can have severe consequences on health and life expectancy of an individual. Unfortunately, extreme obesity has taken almost epidemic proportions on a global scale, and there is a need for a solution that can deliver substantial weight loss quickly.

In such instances, surgery is the only option, and minimally invasive bariatric procedures have become quite popular. However, this surgical procedure may not be suited for everybody who is obese and there are certain important guidelines that have to be considered before opting for this surgery.

Guidelines for Selecting Patients

Laparoscopic bariatric surgery is mostly recommended for people who are morbidly obese and have a BMI (Body Mass Index) of more than 40 kg/m2 or at least equal to or more than 35 kg/m2. However, even for such people, surgery should be an option only if they have failed to lose weight through diets and exercises. The patient should be made aware that being morbidly obese can cause severe health complications, and reduce life span, and these should be motivating factor enough for going through with the surgery. The patient should be mentally competent to consider the advantages of the surgery, and should be free of any serious psychological diseases.

Considering Risk Factors

Laparoscopic bariatric surgery has a very low failure rate, with 61.2% excess body weight loss on an average. Adverse effects from the surgery could vary between the different laparoscopic procedures, and in high-risk patients occurrence of adverse effect could be as high as 20%. According to available statistics mortality rates are 1.1% in Biliopancreatic diversion (BPD) procedure, 0.5% in Roux-en-Y gastric bypass (RGB) procedure, and 0.1% in gastric banding.

However, for bariatric surgery there are no absolute contraindications. Relative contraindications to bariatric surgery could include end-stage lung disease, unstable coronary artery disease, severe heart failure, severe impairment of intellectual capacity, uncontrolled alcohol or drug dependency, cirrihosis, and active cancer treatment or diagnosis.

Laparoscopic bariatric surgery is not prescribed to patients –

Who are intolerant to pneumoperitoneum physiologically
Who have high BMI combined with central obesity
Who have a large liver
Who severe adhesions in intra-abdominal area
Who have huge ventral hernias

Super Obese Patients

Earlier super obese patients having BMI of more than 60 or 50 kg/m2 were declined laparoscopic bariatric surgery because of certain technical challenges and supposed high risk factors. However, later with the improvement of endosurgical equipment and techniques, laparoscopic Adjustable Gastric Band (AGB) and RGB procedures are now being commonly done for super obese patients.

Age Considerations

Restricting laparoscopic bariatric surgery due to advanced age is now becoming less employed as quality of surgery has improved, critical care has proven effective, and anesthesiology has been greatly refined. Even patients older than 55 to 60 years are undergoing this procedure. However, such patients need to stay longer in the hospital and their weight loss will be less compared to younger patients. Morbidity and mortality risks will also be higher and co-morbidities resolution will be incomplete.

Previously, due to insufficient data, laparoscopic bariatric surgery was not recommended for morbidly obese adolescents and children. However, now, it has been seen that RGB procedure is well tolerated by patients less than 18 years of age; nevertheless, they need follow-up care for 10 years. Secondly, the procedure should be performed at a specialty center. Some experts believe that weight reduction through bariatric surgery at early ages can help minimize or even prevent physical outcomes of obesity.

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