Stomach Surgery For More Patients

Bariatric surgery guidelines revised in three medical bariatric societies

(RxWiki News) Surgery to shrink the stomach has typically been reserved for extremely overweight patients having trouble losing the pounds. But new bariatric surgery guidelines suggest that the procedure might not be just for the obese.

Three major medical societies recently revised their guidelines to open metabolic and bariatric surgery to older patients and mild to moderately obese patients. The new guidelines also address how to choose the right surgical method. 

The changes are based on research done over the last four years to help doctors, surgeons and other health professionals make informed decisions to benefit patients, according to researchers.

"Talk to a surgeon about the best surgery for you."

Seventy-four recommendations were made under the update, 56 of which were revisions to the old recommendations and two new recommendations. The original set of guidelines was written in 2008 with 164 recommendations.

New evidence over the last four years prompted the recommendation changes.

Jeffrey Mechanick, MD, co-chair of the Icahn School of Medicine at Mount Sinai in New York, led the revision process.

Previously, sleeve gastrectomy – a procedure in which 85 percent of the stomach is removed – was classified as an investigational technique. Under the new recommendations, the procedure is now classified as a proven option for weight loss surgery and metabolic control.

The guidelines recommend that surgical methods be chosen based on the individual patient's goals and motivations, and the surgeons’ and institutions’ experience and expertise.

Another guideline in the revisions suggests expanding surgical eligibility to include patients with mild to moderate obesity and patients with metabolic syndrome or diabetes.

According to the guidelines, there is insufficient evidence for recommending that the procedure be limited to patients based solely on glycemic control, cardiovascular disease risk reduction and decreasing lipids (fat cells).

"There appears to be no real medical evidence supporting a specific BMI cutoff," said Maxwell Chait, MD, a gastroenterologist with ColumbiaDoctors Medical Group and dailyRx Contributing Expert.

"The guidelines recognize that surgery should be considered when other options fail," said Dr. Chait.

Other guidelines include:

  • Request women avoid getting pregnant before surgery and a year to 18 months after surgery
  • Using a team approach to surgical care in order to monitor nutritional and metabolic issues
  • Patient screening and selection
  • Pre- and post-operative management
  • Criteria for hospital readmission after surgery

"The guidelines reveal a common view among physicians and surgeons in terms of considering this therapy as an important treatment option for patients with obesity and metabolic disorders such as type 2 diabetes, hypertension, hyperlipidemia, or obstructive sleep apnea," Dr. Chait said.

The new guidelines were published in the March 2013 issue of the journal Surgery for Obesity and Related Diseases, Endocrine Practice, and Obesity.

The guidelines were endorsed by the European Association for the Study of Obesity (EASO), International Association for the Study of Obesity (IASO), International Society for the Perioperative Care of the Obese Patient (ISPCOP), Society American Gastrointestinal Endoscopic Surgeons (SAGES), American College of Surgery (ACS) and International Federation for the Surgery of Obesity and Metabolic Disorders.

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Review Date: 
April 15, 2013