Indications and Contraindications for Bariatric Surgery
Defining the indications for metabolic and bariatric surgery begins with an assessment of the risk-benefit ratio of a given procedure against that of morbid obesity. Significant advances in surgical techniques, reductions in operative risk, and greater knowledge of the harmful sequelae of untreated obesity have greatly altered the risk-benefit ratio of surgery since the 1991 NIH consensus statement. In addition, the health and mortality risk of untreated obesity is better defined and higher than was previously appreciated. The result is a shift in the risk-benefit analysis favoring surgery, leading to consideration of lowering the body mass index (BMI) indications for metabolic and bariatric surgery. There are few absolute contraindications to metabolic and bariatric surgery. Most would be included in lists of contraindications of any elective surgical procedure. Patients deemed to have a prohibitive operative risk should not be offered surgery. Bariatric surgery should not be performed on patients with limited life expectancy. Patients who are pregnant or who expect to be pregnant should be deferred. Active drug or alcohol abuse is a relative contraindication to surgery, as is untreated severe psychiatric illness. In the appropriate patient population, however, bariatric surgery is one of the safest elective surgeries.
KeywordsObesity Bariatric surgery Guidelines Indications Contraindications Bariatric consensus statement
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