Contraindications
It is important to know all conditions that may exclude a person from a bariatric program, given that most are relatives.
Who are not candidates for bariatric surgery?
The fact that one person with an obesity prognosis meets the NHI (National Health Consensus) regarding over weight, to undergo bariatric surgery, doesn’t necessarily make you a candidate to such procedures due to the existent relative contradictions that may temporarily or definitely postpone a surgery of such nature.
With the increase of experience in bariatric surgery with minimum invasion and low complications rate currently reported, many of the medical conditions that were previously considered contradictions, are no longer so. Patients are not just evaluated by the surgeon, but also by multidisciplinary groups. The group determines the consensus and according to the general conditions, the current state of the pre-existent illnesses, as well as additional factors that may increase the risk for the patient, the surgical procedure may or may not proceed. They also give recommendations to improve health state and reduce risks.
What can be certain contraindications?
The selection of patients to undergo bariatric surgery has been changing in the last decade, due to the advance in the minimally invasive procedures, technologies and increase of experience. Also, there has been more information on results in specific groups, based on age, weight, related illnesses or comorbidities and severity of these. There are no absolute contradictions in bariatric surgery; however, the benefits expected must surpass the inherent risks of the procedure the patient will undergo. Some relative contraindications may include: severe heart failure, unstable ischemic heart disease, terminally ill pulmonary disease, active oncological disease or under treatment, liver cirrhosis with portal hypertension, active dependency on alcohol or drugs and severely affected intellectual capacity. Other relative contraindications may be related to specific procedures, like for example Crohn’s disease in gastric bypass or bilio-pancreatic bypass. Before, very obese or super obese patients (BMI bigger to 60 Kg/m2), patients with an extensive abdominal surgery background and multiple adherences as well as life extremes were a motif to contraindicate a bariatric surgery. Nowadays there are bariatric programs for adolescents and patients older than 65 years of age. Also, patients with extreme obesity are operated and with severe diseases after they’ve done the pre-op preparation and control of risk factors to lower surgical anesthetic risks.
Most contraindications for bariatric surgery are relative, however, they require of special attention by the multidisciplinary team to improve the patient’s health; also the patient must follow all indications and/or recommendations given by the treating doctor to get the most of the bariatric surgery. In case that the contraindication is or becomes absolute, there are other options less invasive that may be done in a bariatric program.
