Indications for Bariatric Surgery

BMI categories

BMI

Underweight

<18.5

Normal weight

18.5–24.9

Overweight

25–29.9

Obese

>30

Table 5.2

Absolute and relative contraindications to bariatric surgery [1, 2]

Absolute	Relative
Contraindications to general anesthesia	Uncontrolled drug or alcohol dependence
Uncorrectable coagulopathy	Cirrhosis with portal hypertension
Pregnancy	End-stage lung disease
	Active cancer
	Unstable coronary artery disease
	Heart failure

Table 5.3

Comorbidities associated with morbid obesity [2]

Hypertension	Nephrotic syndrome
Coronary artery disease	Thrombophlebitis
Heart failure	Wound infections or dehiscence
Venous stasis ulcers	Sexual hormone dysfunction
Diabetes and insulin intolerance	Necrotizing subcutaneous infections
Degenerative osteoarthritis	Stress urinary incontinence
Cholelithiasis	Gastroesophageal reflux disease
Polycystic ovarian syndrome (PCOS)	Respiratory insufficiency of obesity (Pickwickian syndrome)
Pseudotumor cerebri	Obesity hypoventilation syndrome
Increased intra-abdominal pressure	Obesity sleep apnea syndrome
Nonalcoholic steatohepatitis	Venous disease
Pulmonary embolism

Studies have shown that morbid obesity poses higher perioperative risks. The Obesity Surgery Mortality Risk Score (OS-MRS) predicts the 90-day mortality risk after gastric bypass surgery. It looks at five preoperative variables (Table 5.4). The OS-MRS aids in risk stratification when preoperatively assessing whether bariatric surgery is a safe option for weight loss [1].

Table 5.4

The obesity surgery mortality risk score

Body mass index >50 kg/m²

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