In patients with severe obesity who have been refractory to medical management, surgical procedures may be considered as one method to achieve weight reduction. The presence of certain conditions may serve as contraindications to performing these procedures due to the occurrence of serious complications.


Surgical procedures used for treatment of obesity refractory to medical management:

(1) vertical banded gastroplasty

(2) roux-en-Y gastric bypass


Contraindications to surgical management of severe obesity:

(1) < 100 pounds overweight (< 45 kg)

(2) organic cause for obesity

(3) age > 50 years

(4) serious underlying disease (cardiac, liver or renal)

(5) psychiatric disorder

(6) alcoholism or substance abuse

(7) endogenous depression

(8) misguided or ill-conceived motivation for surgery (or unrealistic expectations)

(9) lack of a support system for follow-up and care after surgery

(10) no attempt at conventional medical therapy for obesity (no history of failure using conventional medical therapy)

(11) history of cholelithiasis or cholecystitis (I am not sure if a history of cholecystectomy would serve to nullify this.)


In addition, some surgeons will not perform surgery unless there has been a proven medical complication to the obesity.


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