Evaluation For Bariatric Surgery

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Evaluation For Bariatric Surgery

Patients who come for treatment of obesity are not taken up for surgery straightaway. The following steps are taken prior to advising a surgery :

First visit :

The initial assessment shall include :

  • Presenting complaints / history
  • Height
  • Weight
  • Body mass index (BMI)
  • Clinical examination: heart rate, blood pressure, respiratory rate, saturation on room air
  • Systemic examination of the cardiovascular system, respiratory system, neurological system and abdominal examination
  • Previous weight loss methods
  • Co-morbid conditions: diabetes mellitus, coronary artery disease, hypothyroidism, dyslipidemia, osteoarthritis, psychiatric illness, obstructive sleep apnoea, cancer, chronic obstructive pulmonary disease, hypertension etc.
  • Family counselling

The initial consultation is done with :

  • Anaesthetist
  • Endocrinologist
  • Pulmonologist
  • Cardiologist
  • Dietician
  • Physiotherapist
  • Intensivist (only in high-risk cases)

Investigations:

3 weeks preoperative

a. Haematology

  • Complete blood count
  • Coagulation profile
  • Fasting and postprandial blood sugar estimation
  • HbA1C (glycosylated haemoglobin)
  • Fasting C- Peptide levels (in diabetics)
  • Urea
  • Creatinine
  • LFT
  • Thyroid profile
  • Fasting lipid profile
  • HIV, HCV, HbsAg
  • Renal profile
  • Serum vitamin B12
  • PTH

b. Radiology

  • Chest x-ray
  • Ultrasound abdomen and pelvis to r/o gallstones and polycystic ovarian disease

c. Cardiac evaluation

  • Resting ECG
  • ECHO

d. Pulmonology

  • Pulmonary function tests (PFT)
  • Sleep study (as decided by anaesthetist / pulmonologist)

e. Gastroenterology

  • OGD to rule out tumour / large hiatal hernia and treat H. Pylori, if positive