Indications and Contraindications for Bariatric Surgery

Abstract

Defining the indications for metabolic and bariatric surgery begins with an assessment of the risk-benefit of a given procedure. Significant advances in surgical techniques, reductions in operative risk, and greater knowledge of the potential risk of untreated obesity have greatly altered the risk-benefit of surgery since 1991. In addition, the health and mortality risk of untreated obesity is better defined and greater than was appreciated in 1991. The result is a shift in the risk-benefit favoring surgery, leading to consideration of lowering the body mass index (BMI) indications for metabolic and bariatric surgery. There are few absolute contraindications to metabolic and bariatric surgery. Most would be included in lists of contraindications of any elective surgical procedure. Patients deemed a prohibitive operative risk should not be offered surgery, including those with contraindications to general anesthesia or uncorrectable coagulopathy. Bariatric surgery should not be performed on patients with limited life expectancy due to irreversible cardiopulmonary or other end-organ failure or metastatic or inoperable malignancy. Patients who are pregnant or who expect to be pregnant within 12 months of surgery should be deferred. Active drug or alcohol abuse is a relative contraindication to surgery, as is untreated severe psychiatric illness. Metabolic and bariatric surgery should be postponed in patients with active peptic ulcer disease until successful treatment has been confirmed.