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