Pre-op blood test:
FBE, ELFT, TFT

Iron, folate, B1, B6, B12, calcium, Vitamin D

Calcium, magnesium, copper, selenium

Fasting blood glucose, cholesterol, triglyceride,

(If you had the blood tests done within 3 months or so, you probably don’t need to repeat them)

 

Pre-op ECG

Please bring a copy of the results with you when you come for the pre-admissions appointment at Gold Coast Private Hospital or on the day of surgery. 

** If you prefer that I send you a pathology form instead, let me know.

** If you can’t get the ECG done with your GP, the nurses here at the Gold Coast Private Hospital will do one on the day of surgery

 

 

Pre-op gastroscopy

Pre-op gastroscopy before bariatric surgery is a subject of ongoing debate

• ASMBS recommend gastroscopy based on patient symptoms and surgeon’s preferences
• IFSO 2020 recommend routine pre-op gastroscopy for asymptomatic and symptomatic patients

IFSO reported 25.3% of asymptomatic patients have abnormal gastroscopy findings and 16.7% change /delay their surgery

The prevalence of gastric intestinal metaplasia has been reported to be between 2.4 to 2.7% (some report 8.6%) on gastroscopy and biopsies

 

Gastric intestinal metaplasia

• is higher in certain groups (ethnic groups, older men, smokers, HP infection)
• may lead to dysplasia and gastric adenocarcinoma

 

Gastroscopy technique:

Biopsies (x2) taken at antrum and corpus (at lesser and greater curve)

Biopsies (x2) at incisura if intestinal metaplasia is suspected (Sydney biopsy protocol)

Biopsies of GOJ to check for Barrett’s metaplasia/dysplasia (any segment >1cm)

Oesophagitis is documented as LA Angeles classification

Hiatus hernia is classified as Hill (1 -4) classification (>2cm above diaphragm)

 

Post op gastroscopy:

Gastric bypass procedure precludes future gastroscopy surveillance of the remnant stomach

 

 

 

Performance and frailty   Sarcopenic obesity is characterized by changes in metabolism and physiological compensation with reduced muscle mass and functional performance   Older patients with higher risk of sarcopenic obesity undergoing surgery has a higher risk of adverse post op outcomes   Patient assessment includes: *Age (although the is poor correlation between age and frailty) *Pre-op functional status *Ambulation and exercise tolerance *Pre-existing diabetes, cardio-vascular disease, sleep apnoea, etc   After surgery massive weight loss, weakness and low level of physical activity pre-op exacerbates the post op fitness and performance