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