Pre-Operative Bariatric Surgery Screening

May 11, 2009

Multi-disciplinary Team Approach

Attempting to maximize patients’ chances of having a successful surgical outcome starts with education and knowledge. Although much is gained through personal research, studies show that the pre-operative education and evaluations from a multi-disciplinary team approach of professionals working with the same goal lead to a higher likelihood of successful surgical outcomes.

This team consists of more than the just the surgeon who performs the operation. It includes the many dedicated consultants who evaluate to ensure a safe surgery. Also involved are a team of nurses who routinely take care of bariatric patients post-operatively. Bariatric coordinators of the office and of the hospital who act as immediate contact people for support and questions.

The entire philosophy and mutual goal of the multi-disciplinary team is to carefully screen all patients before the surgery to identify any potential problems and correct as appropriate to ensure safety and success during and after the operation.

Pre-operative Screening Starts with Thorough Exam

Initial evaluation starts with a full history and physical examination by your surgeon. During this time, extensive questions are asked about not only active medical problems, previous surgeries, active medications, and allergies, but a fair number of questions will be directed to factors that are obesity related. Number of years trying conservative therapy for weight loss is noted. Any previous organized weight loss programs or supervised programs by professionals that have been involved in the past are accounted for. Thorough diet history, eating habits, and eating tendencies are documented. Previous use of diet medications are asked. Even the level of routine exercise or ability for physical activity will be compiled in the work up.

Required Consultants

After the initial evaluation by your surgeon, all potential patients will meet with a registered dietitian. Emphasis on the post-operative bariatric diet is of the utmost importance - not only in what you eat, but also how to eat, when to eat, and why not to eat certain things. Education on the stages of the bariatric diet is also reviewed. Timing for certain stages of the diet with particular procedures are also explained. (Also see later chapters in the manual for further information on bariatric diet.)

Another necessary consult involves a psychological evaluation by a trained, licensed professional. During this consultation, a unique history is obtained to ensure that potential patients have the capacity to understand fully the magnitude of commitment that bariatric surgery requires for good outcomes. This process involves identifying major untreated psychiatric disorders, dangerous eating disorders, and poor coping skills in some patients that may hinder their success post-operatively. Major depression and other psychological burdens are commonly seen in obese people. Failure to identify these people may lead to difficulty with behavioral modifications and compliance necessary for safety after the surgery.

Potential Other Consultants

In addition, depending on active medical issues and current health related complaints, other consultants will help in evaluating patients. Any persons with previous heart condition or history of prior diet medications will be seen by a cardiologist. Anyone who has asthma, obstructive sleep apnea, or reactive airway disease will be seen by a pulmonologist. Also seen by the pulmonologist will be anyone with undiagnosed sleep apnea, and whose sleeping score may suggest this medical problem. Endocrinology consult as well as exercise physiologist when deemed appropriate.

Potential Pre-operative Procedures

In the work-up for bariatric surgery, all patients with symptoms of reflux will undergo upper endoscopy to evaluate the small bowel, stomach, and esophagus from the inside. All patients who will be undergoing a gastric bypass will also have an upper endoscopy to insure that no ulcerations, masses, or polyps are located in the future remnant stomach that will basically be unaccessible after the surgery

Generally, colonoscopies are not routinely performed, but are done if necessary from a general surgical standpoint.

Education on Bariatrics

Throughout the pre-operative course, knowledge is the key to a successful outcome in bariatric surgery. One of the first educational sessions include the "Weight-Loss Surgery" Seminar directed to potential patients. This education continues as further available organized lectures are provided by the bariatric coordinator. In addition to this manual which will serve the majority of the basis of your education, other commercial media and reading material is also available upon request at your surgeon’s office.

All potential patients’ knowledge of bariatric surgery will be demonstrated by a pre-operative knowledge based exam. In order to assure that patients fully understand all the details of the surgery, risks, benefits, post-operative diet and behavioral modifications, they must have a passing score on this exam in order to proceed with any surgery.