PRE-OPERATIVE WORKUP

Comprehensive evaluations and tests before surgery ensure patient safety and optimal outcomes. Here’s what to expect:

Blood Tests

Blood tests provide a thorough assessment of a patient’s overall health, identifying any potential underlying conditions. These include:

Complete blood count (CBC)
Lipid profile (triglycerides, total cholesterol, LDL, HDL)
Protein profile
Blood glucose with HbA1c (glycated hemoglobin)
Coagulation times (PT, PTT, D-dimer, fibrinogen)
Kidney function tests (urea, creatinine, electrolytes)

In some cases, it’s necessary to evaluate thyroid function (fT3, fT4, and TSH), adrenal function (cortisol levels pre- and post-dexamethasone stimulation), or hormone levels (e.g., estrogen, FSH, LH, testosterone), especially for patients with polycystic ovary syndrome (PCOS). Preoperative vitamin levels, including B12, D3, and folic acid, are also crucial as they help guide post-operative supplementation.

Cardiological Assessment

A baseline electrocardiogram (ECG) is essential for all patients. Patients with a high BMI or history of heart conditions may require a more detailed cardiological evaluation, including an echocardiogram. If there is a history of ischemic heart disease, a stress test may be advised by the cardiologist as part of the multidisciplinary team.

Respiratory Assessment

A chest X-ray is a standard part of the preoperative assessment. Many patients with obesity suffer from sleep apnea syndrome (OSAS), making it important to perform a Stop-Bang Test. If any abnormalities are detected, a polysomnography might be required to monitor snoring and apnea indices. In rare cases, preoperative C-PAP therapy can help reduce postoperative respiratory complications.

Venous Doppler Ultrasound

A Doppler ultrasound of the lower limbs helps identify deep venous insufficiency. This condition may require the use of elastic compression stockings alongside standard low-molecular-weight heparin therapy during the perioperative period. Intraoperative pneumatic compression can also be used to improve venous return and reduce the risk of thromboembolic complications.

Abdominal Ultrasound

An abdominal ultrasound assesses the overall health of the abdomen, focusing on detecting gallstones. If gallstones are present, a cholecystectomy might be performed simultaneously with the bariatric procedure.

Esophago-Gastro-Duodenoscopy

This critical endoscopic evaluation helps diagnose gastroesophageal reflux (including hiatal hernia and esophagitis), gastric conditions, Helicobacter pylori infection, and metaplastic changes in the stomach lining that may contraindicate specific bariatric surgeries.

Dietary Assessment

A dietary evaluation involves keeping a food diary to understand the eating habits of patients undergoing bariatric surgery. It helps identify eating disorders that need to be addressed before surgery and often includes a psychological-psychiatric evaluation.

Psychological/Psychiatric Assessment

Eating disorders (ED) can be signs of deeper psychological distress. The psychologist’s role is to identify and address these issues, working closely with the patient. For more complex cases, a psychiatrist may provide a formal diagnosis and develop a treatment plan to improve mental health. Both assessments are vital in determining a patient’s readiness for bariatric surgery.