Chapter 11: Bariatric & Metabolic Surgery — What's Up in Surgery? Live book

Ch 11 · Bariatric & Metabolic SurgeryAdoptPractice shift

Practice Shift — Bariatric Eligibility: 2022 ASMBS/IFSO Clinical Indications, Not 1991 Cutoffs or Administrative Criteria (Table 8.1, Pathway 8A)

Judge bariatric eligibility by the 2022 ASMBS/IFSO clinical indications — BMI >=35 kg/m2 regardless of comorbidities; consider BMI 30–34.9 kg/m2 (>=27.5 in Asian populations) with inadequately controlled T2DM — and choose LSG, RYGB or OAGB (<=150 cm limb) by shared decision-making, not by 1991 NIH cutoffs or a universal 'best' operation.

⏳ Pending triple review — converted from the book; Pass 1 · Pass 2 · author sign-off still to come.

Flip the card — evidence, steps & sources

Practice Shift — Bariatric Eligibility: 2022 ASMBS/IFSO Clinical Indications, Not 1991 Cutoffs or Administrative Criteria (Table 8.1, Pathway 8A)

Summary — the change

Apply 2022 ASMBS/IFSO clinical indications (BMI >=35 kg/m2 regardless of comorbidities; consider at BMI 30–34.9 kg/m2 [>=27.5 kg/m2 in Asian populations] with inadequately controlled T2DM/metabolic disease after multidisciplinary evaluation) while verifying local Saudi MOH/insurance administrative criteria separately. Select LSG, RYGB, or OAGB (<=150 cm limb) via shared decision-making across expected weight loss, diabetes remission/relapse, GERD/Barrett's status, nutritional risk, follow-up adherence, and team experience.

Before → Now

Before: Relying solely on 1991 NIH BMI cutoffs (>=40 or >=35 kg/m2) without comorbidity/metabolic assessment, pooling SLEEVEPASS/SM-BOSS/STAMPEDE/YOMEGA as interchangeable, or ranking one operation as universally 'best'.

Now: Apply 2022 ASMBS/IFSO clinical indications (BMI >=35 kg/m2 regardless of comorbidities; consider at BMI 30–34.9 kg/m2 [>=27.5 kg/m2 in Asian populations] with inadequately controlled T2DM/metabolic disease after multidisciplinary evaluation) while verifying local Saudi MOH/insurance administrative criteria separately. Select LSG, RYGB, or OAGB (<=150 cm limb) via shared decision-making across expected weight loss, diabetes remission/relapse, GERD/Barrett's status, nutritional risk, follow-up adherence, and team experience.

Who it applies to

Adults with obesity and metabolic disease (ASMBS/IFSO 2022; STAMPEDE 5-y, SLEEVEPASS 10-y, SM-BOSS 5-y, YOMEGA 2/5-y). Outcomes rated in the matrix: weight loss, diabetes remission (by trial definition), GERD, and nutritional safety.

Exclusions & exceptions

The four trials are appraised separately, never pooled: STAMPEDE (5-y HbA1c <=6.0% without diabetes medications: 22.4% [11/49] RYGB vs. 14.9% [7/47] LSG vs. 0% [0/38] medical therapy; 90% 5-y follow-up); SLEEVEPASS (10-y %EWL: 43.5% LSG vs. 51.9% RYGB; de novo esophagitis 31% vs. 7%, p < 0.001; 80.4% 10-y follow-up); SM-BOSS (5-y %EBMIL: 61.1% LSG vs. 68.3% RYGB, p = 0.22; 94.5% 5-y follow-up); YOMEGA (200-cm OAGB non-inferior %EBMIL at 2 y [−87.9% vs. −85.8%] but 9 nutritional SAEs vs. 0 in RYGB, p = 0.0034; 85% 2-y follow-up).

Regional check — Saudi / GCC

Saudi & Gulf (GCC) frame (§8.0): the 2016 Saudi Clinical Practice Guideline for Overweight and Obesity in Adults (Alfadda et al., PMID 27652370) is the chapter's formal Saudi GRADE guideline layer, stated separately from the 2022 ASMBS/IFSO clinical indications. Local insurance, hospital, and Saudi MOH administrative eligibility criteria may still differ from the clinical indications and must be verified locally; local SFDA product labels, hospital formularies, bariatric service capacity, and referral pathways must be confirmed locally.

Sources

Verification stamp: ⏳ Pending triple review · Seed card (Wave 6), converted from What's Up in Surgery? v2.5 Table 8.1 Pathway 8A and the §8.0 Saudi/GCC frame. Matrix rating: Strong for BMI >=35 / Conditional for BMI 30–34.9 with T2DM; Moderate-to-High certainty. Status set to adopt on the Strong element; the Conditional BMI 30–34.9 element is carried verbatim in now/appliesTo rather than downgrading the whole card (mirrors Wave 2 card 3 / Wave 3 card 3 / Wave 4 card 1) — flagged for the triple-review session to confirm. Pending triple review. Permalink to this card

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Practice shifts

Practice Shift — Bariatric Eligibility: 2022 ASMBS/IFSO Clinical Indications, Not 1991 Cutoffs or Administrative Criteria (Table 8.1, Pathway 8A)