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Perioperative Management
Preoperative Management
➤ Medical evaluation
• Comprehensive history and physical examination with attention to
obesity-related comorbidities.
• Screening for cardiovascular risk, including electrocardiogram,
stress testing, or cardiology referral as indicated.
• Management of diabetes mellitus, hypertension, and other chronic
conditions before surgery.
• Evaluation of sleep apnea with polysomnography if clinically indicated;
initiation of continuous positive airway pressure when indicated.
➤ Psychological Evaluation
• Screening for untreated psychiatric disorders, substance use,
eating disorders, and cognitive impairments.
• Identif ication of behavioral risks that may affect adherence to the
postoperative plan.
• Support patients in establishing realistic expectations and
enhancing motivation.
➤ Smoking and Alcohol Cessation
• Nicotine use increases the risk of surgical complications and
marginal ulceration; cessation is typically required two to three
months before surgery.
• Patients with alcohol use disorder should be referred for
counseling and stabilization preoperatively.
➤ Nutritional Assessment
• Evaluation by a registered dietitian with expertise in bariatric care.
• Assessment of current dietary habits, potential nutritional
def iciencies, eating behaviors, and readiness for change.
• Education on postoperative dietary progression, lifelong
supplementation, and protein intake goals. Patients should be able
to demonstrate their plan to meet nutritional needs after surgery.
➤ Medically Supervised Weight Loss
• Often required by insurance, but clinical evidence for eff icacy in
reducing surgical risk is limited.
• May aid in preoperative behavior change and reduce liver volume,
which is benef icial for laparoscopic access.
• Should not delay surgery for motivated and medically appropriate
candidates. However, consider the weight limitations of all equipment.
➤ Education and Informed Consent
• Reinforce prior counseling about surgical options, outcomes, risks,
and expectations.
• Document patient understanding of lifelong follow-up, dietary and
supplement needs, and behavior modif ication.
