In keeping with the National Institutes of Health Consensus Development Conference Statement on Gastrointestinal Surgery for Morbid Obesity, patients with a BMI exceeding 40 kg per m2 or 35 kg per m2 with obesity-related comorbidities are candidates for the surgical treatment of morbid obesity.10 Surgery for morbid obesity should be offered to patients who are well-informed and motivated, and who are acceptable to operative risks. Patients should be evaluated preoperatively by a mul-tidisciplinary team of nutritionists, nurse clinicians, internists, psychologists or psychiatrists, and surgeons. Patients should be screened for common obesity-related conditions, and these conditions should be optimized. Tests to be considered are chest x-ray; electrocardiography, cardiac stress testing, and echocardiography for cardiac disorders; arterial blood-gas and pulmonary-function testing, with arterial blood gases for the hypoventilation syndrome and polysomnography for the sleep apnea syndrome; barium swallow; TS, lipid panel, HbA1c, and fasting blood sugar. The choice of procedures with risks and benefits must be clearly explained to the patient, as should be the need for long-term follow-up.
The optimal operation is still a matter of much discussion. In reality, careful patient selection can result in a close match between operation and patient. This also includes the very real and not-too-infrequent denial of any surgical option for the inappropriate surgical candidate. The most commonly performed surgical procedures in the U.S. are the Lap-Band, the Roux en Y gastric bypass, and the bilopancreatic diversion.
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