Indications and Contraindications for bariatric/weight-loss surgery

Even given the technical progress made in terms of surgery practices and anaesthetics, any surgery undertaken on morbidly obese patients is considered as being high risk.

To avoid treatment risks being higher than the risks posed by the medical problem itself, very specific surgical indications were adopted by several consensus conferences.

Surgery is recommended for patients whose BMI (body mass index) is greater than, or equal to, 40 Kg/m².

It can also be recommended for people with a BMI greater that 35 Kg/m² who suffer from one or more comorbidities related to obesity. (Comorbidity – a disease or medical condition that is simultaneously present with another or others in a patient.)

Furthermore, they must have had a problem with obesity for at least five years, their dietetic/conservative treatment is not working, and, of course, there must be no surgical contraindications.

Surgical contraindications include:

• Drug dependency
• Psychosis
• Serious liver or kidney failure  (except as part of the pre-transplant preparation)
• Inflammatory bowel disease
• Uncontrolled tumour diseases
• Recent history of thrombosis or pulmonary embolism

Reducing pre-operative risks

Stop smoking 1 month before the scheduled surgery to reduce the risk of complications.

Stop drinking alcohol 1 month before the scheduled surgery.

Low-calorie diet, low in sugar = reduces the size of your liver. It is very important to start this diet 6 weeks before the scheduled surgery to guarantee a successful outcome.

The importance of whole-life surgery follow-up: obesity as a chronic disease

Having the cost of your obesity surgery covered and/or reimbursed by your health insurance is only open to those patients in compliance with these selection criteria.

All patient files are discussed on a multidisciplinary basis to validate surgery indications.

Post bariatric/weight-loss surgery follow-up is indispensable on a whole-life basis for the patient being operated where obesity is a chronic disease.

Such regular follow-up reduces the number of patients where contact is lost, and helps detect early or late post-surgery complications, whether mechanical, metabolic or psychiatric.

It is worth noting that psychiatric/mental health problems are frequent, ranging from depression to suicide, including the manifestation of addictions, which are important to detect.

Finally, post-surgery follow-up allows the early detection of postoperative complications, or the actual failure of the bariatric/weight-loss surgery, as evidenced by insufficient weight-loss in the long term, or eventual weight-gain.