7 - Pre-operative surgical management

Summary

The pre-operative assessment of candidates for bariatric procedures is based on the principle of identifying modifiable health concerns and implementing risk reducing treatments to reduce peri-operative morbidity and mortality. Most bariatric patients have known conditions, which are already being treated by a primary care physician (PCP), alleviating the need to perform additional probing tests. Patients with unlimited exercise tolerance have half the risk of serious post-operative complications compared to those with a low tolerance. Excessive weight infringes on the chest wall, rib cage, and diaphragm, directly affecting pulmonary function in morbidly obese (MO) patients. Although psychiatric evaluation for patients seeking bariatric surgery is considered important, at the present time there is a lack of consensus as to how to proceed. Nutritional evaluation should also be initiated prior to surgery. Appropriate evaluation of the bariatric patient seeks to identify modifiable risk factors and can exclude poor candidates prior to surgery.