Obesity: Bariatric Surgery

Question 1

Who does NICe suggest we consider bariatric surgery on?

Answer 1

• BMI of >=40
• BMI 35-40 & other significant disease (e.g. type 2 diabetes mellitus, hypertension) that could be improved with weight loss.
• All appropriate non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months
• They are receiving or will receive intensive specialist management
• They are generally fit for anaesthesia and surgery
• They commit to the need for long-term follow-up

Question 2

When should surgery be considered first line?

Answer 2

In adults if the BMI is > 50.

Question 3

What are the types of bariatric surgery?

Answer 3

• Primarily restrictive: laparoscopic-adjustable gastric banding (LAGB) or sleeve gastrectomy
• Primarily malabsorptive: classic biliopancreatic diversion (BPD) has now largely been replaced by biliopancreatic diversion with duodenal switch
• Mixed: Roux-en-Y gastric bypass surgery

Question 4

Which surgical procedure is usually chosen for which patients?

Answer 4

• LAGB (banding) produces less weight loss than malabsorptive or mixed procedures but as it has fewer complications it is normally the first-line intervention in patients with a BMI of 30-39.
• Patients with a BMI > 40 may be considered for a gastric bypass or sleeve gastrectomy. The latter may be done as a sole procedure or as an initial procedure prior to bypass
• Primarily malabsorptive procedures are usually reserved for very obese patients (e.g. BMI > 60 kg/m^2)