Section 3.4 Bariatric Surgery

Key Points

  • Four weight-loss surgical options are available
    • Laparoscopic adjustable gastric band (LAGB)
    • Laparscopic sleeve gastrectomy (LSG)
    • Biliopancreatic diversion with or without duodenal switch (BPD-DS) and with or without LSG (staged BPD)
    • Roux-en-Y gastric bypass (RYGB)
  • BPD-DS and RYGB yield greater weight loss but more post-surgical morbidity than LSG or LAGB
  • Surgical candidates should be selected carefully with consideration of psychosocial as well as medical factors
  • Nutritional and metabolic follow-up are vital to ensure positive outcomes

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendation1

  • R120. Patients with a body mass index (BMI) of ≥40 kg/m2 without coexisting medical problems and for whom the procedure would not be associated with excessive risk should be eligible for bariatric surgery.
  • R121. Patients with a BMI of ≥35 kg/m2 and 1 or more severe obesity-related complications, including type 2 diabetes (T2D), hypertension, obstructive sleep apnea, obesity-hypoventilation syndrome, Pickwickian syndrome, nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, pseudotumor cerebri, gastroesophageal reflux disease, asthma, venous stasis disease, severe urinary incontinence, debilitating arthritis, or considerably impaired quality of life may also be considered for a bariatric surgery procedure. Patients with BMI of 30 to 34.9 kg/m2 with diabetes or metabolic syndrome may also be considered for a bariatric procedure, although current evidence is limited by the number of patients studied and lack of long-term data demonstrating net benefit.
  • R122. Independent of BMI criteria, there is insufficient evidence for recommending a bariatric surgical procedure specifically for glycemic control alone, lipid lowering alone, or cardiovascular disease (CVD) risk reduction alone.
  • R123. All patients should undergo pre-operative evaluation for weight-related complications and causes of obesity, with special attention directed to factors that could affect a recommendation for bariatric surgery or be ameliorated by weight loss resulting from the procedure.

Reference

  1. Garvey WT, Mechanick JL, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract. 2016;22(suppl 3);1-205.