Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Abstract

Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res. 2005;13:234 -243. Objective: To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression. Discussion: Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short-and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

“…In addition to the routine pre-operative assessment as for any other major abdominal surgery, the patient should undergo further assessment for (depending on the planned bariatric procedure and clinical status of the patient) (EL A, B, C, D [16,[78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] ):…”

Case Study: A Patient With Diabetes and Weight-Loss Surgery

“…There is, however, malabsorption of micronutrients with the RYGB resulting from the bypassing of a major portion of the stomach and duodenum. The bypassed portion of the stomach produces the intrinsic factor needed for the absorption of vitamin B 12 . The duodenum is where many of the fat-soluble vitamins, B vitamins, calcium, and iron are absorbed.…”

Best Practice Recommendations for Surgical Care in Weight Loss Surgery

“…Additional considerations taken into account by most weight loss surgeons include family support, motivation, prior attempts at weight loss, and commitment to long-term follow-up. A multidisciplinary team is crucial for providing the comprehensive pre-and postoperative care required by complex WLS patients (58). Optimally, the team should include dedicated surgeons, internists, psychiatrists, dietitians, nutritionists, and nurses (3).…”