Controversy exists regarding the preoperative workup for bariatric surgery. We review the literature on these aspects of the bariatric workup and offer evidence-based guidelines.
Methods:
PubMed search terms were as follows: “preoperative esophagogastroduodenoscopy and bariatric surgery,” “cholecystectomy and bariatric surgery,” “obstructive sleep apnea bariatric surgery,” and “adolescent obstructive sleep apnea and bariatric surgery.”
Results:
Recommend esophagogastroduodenoscopy (EGD) for Roux-en-Y gastric bypass (RNYGB) in symptomatic patients with positive Helicobacter pylori serology. We recommend an optional EGD for RNYGB in asymptomatic patients with positive or negative H. pylori serology. Recommend optional EGD in asymptomatic sleeve gastrectomy (SG) patients with H. pylori-positive serology. Recommend EGD, or other imaging modality, in symptomatic SG patients with H. pylori serology. Recommend optional imaging for asymptomatic SG patients with negative H. pylori serology. In SG patients with symptomatic reflux, we recommend EGD, or other imaging modality. We recommend polysomnography testing in patients who test positive on screening questionnaire or clinically suspect obstructive sleep apnea. We recommend against the routine use of concomitant cholecystectomy at the time of bariatric surgery for asymptomatic cholelithiasis. We recommend cholecystectomy be performed before bariatric surgery for symptomatic cholelithiasis.
Conclusion:
These recommendations strive to offer our patients the safest and most comprehensive preoperative workup.
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