Success of a bariatric surgery will always depend on a series of factors. To be an effective and safe procedure requires a great dedication and a complete understanding of how to manage obese patients. The clinical and surgical team should consider morbid obesity as a disease and not a concern regarding moral failing. When a medical team decides to be involved with a bariatric surgery program, all must be prepared to care for critically ill bariatric surgical patients with regards to cardiopulmonary failure, serious wound problems, and ventilatory and nutritional support. Besides doctors it is necessary to have a complex team prepared to give support, such as nurses, social workers, dieticians, and physical therapists. The infrastructure of the hospital must have beds, wheelchairs, stretchers, chairs, and image and surgical equipment capable of managing very obese patients. The great majority of patients have clinical problems that are poorly controlled and also a number of cardiovascular risks that certainly should be treated and established before surgery. The active participation of all patients in both preoperative and postoperative periods is mandatory. This is an opportunity for patients and family to understand the necessity of modifications in life habits for all life. The patients’ understanding of the future consequences of bariatric surgery is a precondition for the success.1 The list of comorbid diseases associated with obesity is long and all of them must be documented and controlled to decrease the risk of the procedure. The preoperative period should involve patient education and behavior modification, wide-approach medical evaluation for risk assessment, and intensive care for its reduction.
Expert anesthesiology support, knowledgeable in the specific problems of the bariatric patient, is certainly necessary (see Chapter 10). The anesthesiology support includes an understanding of patient positioning, blood volume and cardiac output changes, airway maintenance, and drug pharmacokinetics in the morbidly obese. It is advisable to have preoperative, intraoperative, and postoperative written protocols. The bariatric surgeon must be able to manage, and have coverage to manage, the postoperative patient and any problems and complications that may occur.
Patients eligible for surgical correction of obesity must be aware that this procedure is only an option for severely obese patients who fail to maintain weight loss after trying medical weight loss strategies, such as modifications in diet, behavior, and exercise, and medically supervised weight loss regimens. Most importantly, only those patients, who are willing to make this complete modification a way of life, should be considered for surgery. Psychiatric disorders, drugs, and alcohol abuse and important organ failure are contraindications for surgery. Considering all these particulars, the mortality rate will be less than 1% and acceptable for bariatric surgery.
The education for patients and family must include the rationale for surgical treatment of obesity. This will consist of information about health risks of obesity by itself and all medical hazards associated with treatment. Certainly, the improvement of quality of life must be the base for ...