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Contraindications and Risk Assessment
Contraindications and Risk Assessment
Absolute Contraindications
➤ Untreated or unstable psychiatric illness, such as active
psychosis or severe depression with suicidal ideation.
➤ Active substance use disorder.
➤ Severe, untreated eating disorders such as bulimia nervosa.
➤ Inability or unwillingness to participate in long-term follow-
up and required lifestyle changes.
➤ Contraindications to general anesthesia or prohibitive
surgical risk without modifiable factors.
Relative Contraindications
➤ Advanced age or frailty (individualized decision-making is
advised).
➤ Prior abdominal surgeries or adhesions (may influence
procedure choice).
➤ Complex or uncontrolled medical comorbidities (eg, severe
pulmonary hypertension).
➤ Pregnancy or plans for pregnancy within 12 to 18 months
postoperatively.
Risk Assessment and Optimization
➤ Comprehensive preoperative risk evaluation should be
interdisciplinary and include:
• Nutritional risk assessment: Identify def iciencies,
malnutrition, or behaviors that may impair recovery.
• Cardiopulmonary evaluation: Baseline electrocardiogram
(ECG), pulmonary function tests, or sleep studies as indicated.
• Diabetes control: Optimize glycemic management and
consider the impact of perioperative insulin resistance.
• Frailty and functional status: Particularly relevant for older
adults.
• Thromboembolic risk: Consider pharmacologic prophylaxis,
an inferior vena cava f ilter in select patients.
