The preparation journey
Bariatric surgery requires extensive preparation to ensure you are physically and mentally ready for the dramatic lifestyle change you are planning to undergo.
During the preparation phase, you will meet several specialists who will assess various aspects of your health. This is both to validate that bariatric surgery is the right option for you and, if so, to optimise your health prior to surgery.
Here is a list of some of the assessments required. Please note that each bariatric centre will follow its own protocol. Speak to your specialist for more information about pre-surgery assessments.
Respiratory medicine assessment and consultation
- Respiratory diseases are common in connection with obesity and your team will advise if tests are required. The higher the BMI, the more common they are.
- Respiratory testing investigates three obesity-related issues:
- Sleep apnoea syndrome (SAS): Patients with sleep apnoea are at higher risk of anaesthesia-related complications. You may be required to wear a special device at night.
- Respiratory failure
- Asthma
- The respiratory medicine consultation will consist of testing for these three issues by means of:
- A history assessment and pulmonary examination
- A Pulmonary Function Test (PFT) – breathing test
- A blood gas measurement – a measurement of the amount of oxygen and carbon dioxide in the blood, done by pricking an artery in the wrist
- A polysomnography – testing for sleep apnoea syndrome
Cardiology assessment and consultation
The two objectives of the cardiology consultation are:
- To assess or detect any diseases associated with obesity: high blood pressure, coronary diseases (infarction, angina pectoris) and vascular diseases (damage to the vessels of the neck and the lower limbs)
- To guide the anaesthesiologist to assess surgical risk
The cardiology consultation includes:
- A history assessment and clinical examination
- An electrocardiogram
- An ultrasound
- A test for ischemia is sometimes conducted – this is a non-invasive screening for coronary diseases (infarction or angina pectoris) by means of a stress test (on a bicycle or treadmill) or by means of a stress scintigraphy or ultrasound imaging
Endocrinology assessment and consultation
The four objectives of the endocrinology consultation are:
- To rule out a hormonal cause of obesity that should be treated before considering surgery
- To assess or detect possible high cholesterol in the blood
- To assess or detect possible diabetes and adapt the treatment to reduce the risk of high blood sugar in the peri-operative period (the period around the time of surgery)
- To prepare a plan for monitoring and treating diabetes beyond the surgical procedure (there will be a need to adjust treatment)
Dietetic assessment
The dietetic assessment comprises:
- A dietary diagnosis
- The development of personalised educational information
A dietician or nutritionist will assess your dietary profile to help you adjust and balance your diet and to set up the first preoperative counselling sessions.
Specifically, they will be assessing for possible eating disorders that require treatment to help you modify your habits before surgery. These modifications are important for the success of the surgery.
Some patients may be required to lose some weight before surgery to make the procedure safer and the recovery easier.
Psychological assessment and consultation
The psychological assessment:
- Assesses your motivation, your ability to implement the necessary behavioural changes and your ability to adhere to the long-term postoperative follow-up programme.
- Identifies contraindications for surgery, such as a serious eating disorder, which can have a dangerous impact on bariatric surgery.
- Proposes additional behavioural management of any psychological problems identified before surgery. Psychotherapy may be prescribed before and after the procedure.
Digestive assessment
A digestive assessment aims to:
- Diagnose and evaluate the state of the stomach by means of a gastro-duodenal fibroscopy using a tiny camera called an endoscope. This procedure looks for the presence of a hiatal hernia, acid reflux and its consequences, or ulcers. In this of an ulcer, a biopsy will be carried out to look for the presence of a bacteria called Helicobacter pylori, which may be causing the ulcer and must be treated before surgery.
- Diagnose and assess the condition of the liver, which often has excess fat. This examination is done by means of an ultrasound and blood test.
Pre-anaesthesia consultation
A thorough medical examination is carried out by an anaesthetist or by a bariatric physician who will liaise with the anaesthetist. This exam gives your healthcare team a better understanding of who you are and your medical and surgical history. It determines which medications you should take, if any.
You will be required to bring to the consultation the results of all the assessments that were prescribed for you.
The anaesthetist will consider all of the results and decide if there are any contraindications for the procedure that is anything indicating that you shouldn’t have the procedure and whether they are temporary or permanent.
If the assessment is incomplete, additional testing may be prescribed for you, such as an electrocardiogram, blood and urine tests and a dental examination. You must bring the results of these tests to the clinic on the day of your surgery.
At this consultation, the type of anaesthesia selected according to your health condition and the surgical procedure will be explained to you. In addition, you may be offered stress management techniques, such as hypnosis and relaxation.
The anaesthetist will explain to you how the procedure and the postoperative follow-up will be carried out (with respect to your personal treatment).
You will also be informed whether a blood transfusion will be necessary.
Please make sure to ask your anaesthetist any other questions you may have.
