nutritional disorders
Metabolic and Bariatric Surgery
Preoperative Evaluation for Metabolic and Bariatric Surgery
Preoperative evaluation consists of Diagnosis and correction of comorbid conditions as much as possible Assessment of readiness and ability to engage in lifestyle modification Exclusion of contraindications to surgery Review of the postoperative diet and assessment of the patient's ability to make dietary changes by a dietitian Identification of any uncontrolled psychiatric disorder and any dependencies that would preclude surgery and identification and discussion of potential obstacles to adherence to lifestyle changes postoperatively by a psychologist or other qualified mental health care practitioner Extensive preoperative evaluation is not routinely necessary, but preoperative testing may be necessary based on clinical findings, and measures to control certain conditions (eg, hypertension) or reduce risk may be taken. Patients at risk of Obstructive Sleep Apnea (OSA) based on clinical suspicion should be screened with Preoperative ECG and other noninvasive cardiac testing is considered if individual risk warrants, even for asymptomatic patients, to identify occult Overview of Coronary Artery Disease . Even though obesity increases risk of Preoperative endoscopy or GI imaging studies should be done if patients have clinically significant GI symptoms. To reduce the risk of marginal ulcers, clinicians may test for and treat Helicobacter pylori Infection , although evidence for the necessity of such treatment preoperatively is inconsistent. Increased liver enzymes, especially alanine aminotransferase (ALT), are common among candidates for metabolic and bariatric surgery and may indicate Metabolic Dysfunction–Associated Liver Disease (MASLD) , previously referred to as fatty liver disease. Clinically significant and persistently elevated liver enzymes should not be assumed to result from fatty liver and should prompt an investigation for other causes. If prophylactic cholecystectomy is planned during metabolic and bariatric surgery (to decrease risk of Patients with obesity are at risk of Vitamin D Deficiency and Dependency and metabolic bone disease, sometimes with secondary Because poorly controlled Diabetes Mellitus (DM) increases the risk of adverse surgical outcomes, glycemic control should be optimized before surgery. A reasonable target range for HbA1c, corresponding to preoperative blood sugar control that may predict shorter hospital stays and improved bariatric procedure outcomes, is 6.5 to 7.0%. Nutrition:Patients with obesity are at risk of nutritional deficiencies, which can be exacerbated postoperatively because food preferences and tolerance change, stomach acidity changes, and absorption from the small intestine is decreased. Routine measurement ofvitamin D, vitamin B12, folate, and iron levels is recommended. For certain patients, measuring levels of other nutrients, such as thiamin (vitamin B1), may also be indicated. Reproductive health:Women of reproductive age should be advised that their fertility may improve after surgery. These women should be counseled on contraceptive choice before and after bariatric procedures and should not become pregnant before surgery and postoperatively for 12 to 18 months. Patients having had malabsorptive procedures should have nutritional surveillance and laboratory testing for nutrient deficiencies during subsequent pregnancies. 