There are certain guidelines that should be met prior to undergoing any bariatric surgery. Bariatric surgery is reserved for patients that are physically and mentally appropriate for this type of surgery. As physicians, surgeons and patients...

are considering bariatric surgery, certain criteria laid out by the NIH and other medical bodies need to be met. Patients must have reached adulthood or achieved their maximum height. This criterion exists so that BMI or body mass index can be calculated correctly. Since BMI is a ratio of weight in kilograms to height in meters squared, BMI calculated at below maximum height would erroneously increase the BMI. Patients undergoing bariatric surgery typically need to have a BMI of at least 40 or 35 with the presence of a serious obesity related disease, such as diabetes or heart disease. Patients must have also failed after faithfully attempting to lose weight with a comprehensive diet and exercise program. Finally, physicians must rule out a medically reversible or hormonal cause for the obesity, such as uncontrolled hypothyroidism.

Patients must also be psychologically appropriate for bariatric surgery. It is very important to determine if the patient’s obesity is caused by a pathological compulsion to eat. If this is the case, bariatric surgery, especially a restrictive procedure such as vertical sleeve gastrectomy is not appropriate. Restrictive surgeries require that the patient be able to control the amount of food that is being consumed. Since the stomach is much smaller after vertical sleeve gastrectomy, the feelings of fullness and satiety come after much less food. However, if the patient suffers from a compulsion to eat, the new smaller stomach will quickly become overwhelmed leading to vomiting, food impaction or disruption of the surgical closure.

Other physical and mental issues need to be ruled out or successfully treated prior to vertical sleeve gastrectomy. Since patients undergoing this procedure are necessarily obese, anesthesia can be particularly risky. In order to overcome the large body mass, anesthesiologists are usually forced to use a large amount of anesthesia, which increases the overall risk. Co-existing heart disease, diabetes and other serious illnesses need to be adequately controlled prior to surgery. Mental health issues such as alcoholism, eating disorders or history of a major psychiatric illness may exclude the patient from being considered for this type of surgery.

Prior to surgery, patients undergo a series of tests to assess risk from the surgery as well as the anesthesia. A pre-surgical physical should be performed by a physician. This will include an electrocardiogram and blood tests to check for any correctable problems prior to surgery. Based on these tests, the doctor will make a determination if the benefits of surgery outweigh the potential risks.

Certain risks of surgery can be minimized through proper preparation. If you smoke, most doctors and surgeons will strongly recommend a smoking cessation program or, at minimum, a nicotine replacement regimen to be used instead of cigarettes. Cigarette smoking damages lung tissue and cessation, even for the week prior to surgery, can help the lungs heal. Smoking also increases the risk of infections and abnormal blood clots so it needs to be dealt with prior to surgery. You will not be permitted to eat at least 12 hours before your surgery (and sometimes longer). Contents that remain undigested in the stomach can increase the risk of serious complications, especially from aspiration (inhaling) of vomit that may be regurgitated during surgery. Also, since the surgery involves removal of the stomach, this organ needs to be completely free of food and partially digested material.

An important issue that should be resolved before agreeing to the procedure is to determine whether your health insurance provider has any peculiar requirements. For example, some insurance providers have stipulated that they will not pay for bariatric surgery, even adjustable gastric banding, unless the patient loses a certain amount of weight before the procedure. In some cases the amount is as much as 10 % of total body weight. There is no strong evidence that this mandatory weight loss improves outcomes and may only dissuade patients from getting any form of weight loss surgery. Regardless of external pressures put in place by some insurers, obese patients seeking weight loss surgery often attempt many weight loss methods before opting for surgery. In fact, failing these methods are considered a medical prerequisite for bariatric surgery.