Gastric Bypass Surgery - Surgical Indications

Surgical Indications

Gastric bypass is indicated for the surgical treatment of morbid obesity, a diagnosis which is made when the patient is seriously obese, has been unable to achieve satisfactory and sustained weight loss by dietary efforts, and is suffering from comorbid conditions which are either life-threatening or a serious impairment to the quality of life.

In the past, serious obesity was interpreted to mean weighing at least 100 pounds (45 kg) more than the "ideal body weight", an actuarially determined body weight at which one was estimated to be likely to live the longest, as determined by the life insurance industry. This criterion failed for persons of short stature.

In 1991, the National Institutes of Health (NIH) sponsored a consensus panel whose recommendations have set the current standard for consideration of surgical treatment, the body mass index (BMI). The BMI is defined as the body weight (in kilograms), divided by the square of the height (in meters). The result is expressed as a number usually between 20 and 70, in units of kilograms per square meter.

The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures:

• People who have a BMI of 40 or higher
• People with a BMI of 35 or higher with one or more related comorbid conditions

The Consensus Panel also emphasized the necessity of multidisciplinary care of the bariatric surgical patient by a team of physicians and therapists to manage associated comorbidities and nutrition, physical activity, behavior, and psychological needs. The surgical procedure is best regarded as a tool which enables the patient to alter lifestyle and eating habits, and to achieve effective and permanent management of their obesity and eating behavior.

Since 1991, major developments in the field of bariatric surgery, particularly laparoscopy, have outdated some of the conclusions of the NIH panel. In 2004, a consensus conference was sponsored by the American Society for Bariatric Surgery (ASBS), which updated the evidence and the conclusions of the NIH panel. This conference, composed of physicians and scientists of both surgical and non-surgical disciplines, reached several conclusions, amongst which were:

• Bariatric surgery is the most effective treatment for morbid obesity.
• Gastric bypass is one of four types of operations for morbid obesity.
• Laparoscopic surgery is equally effective and as safe as open surgery.
• Patients should undergo comprehensive preoperative evaluation and have multi-disciplinary support for optimum outcome.