1. Special Issues in Bariatric Surgery
• Bariatric procedures in Adolescents
• Cost effectiveness
• Quality assurance
• Plastic surgery after weight loss
2. Treatment for insufficient weight loss or weight
regain
• Much of the clinical outcomes data have been extrapolated from
the adult literature, and more evidence is needed to demonstrate
• whether weight loss is durable over time
• the impact on obesity-related conditions such as T2DM,
hypertension, and others
• how often patients experience short- and longer-term
complications
• Despite the clinically significant improvements in weight, diabetes,
cardiometabolic health, and weight-related quality of life that were
observed at 3 years following surgery, the reoperation and
micronutrient risks warrant longer observation and further
study.
3. Cost Effectiveness
Adolescents Adults
• Cost-effectiveness data was lacking,
but limited evidence suggested that
bariatric surgery was cost effective
several years after intervention, but not
immediately.
• Review of the evidence to date
suggests that outpatient costs,
including pharmacy costs, are
significantly reduced after bariatric
surgery.
• By the fifth year of follow-up, bariatric
surgery was found to be cost effective
in adolescent patients when compared
to a cohort of patients with obesity who
had not undergone surgery.
• Long-term inpatient hospital costs are
increased or unchanged in those who
have undergone bariatric surgery
compared with matched nonsurgical
patients, so no long-term net cost
benefit is achieved.
4. Quality Assurance
1998-2003
Emergence of the
laparoscopic
technique for
bariatric surgery
2004
ASMBS-Center of
Excellence (COE)
2005
ACS Bariatric
Surgery Center
Network (BSCN)
2012
The Metabolic and
Bariatric Surgery
Accreditation and
Quality Improvement
Program (MBSAQIP)
5. Plastic Surgery After Weight Loss
• Plastic and reconstructive surgery is now a part of the
continuum of care for bariatric surgery patients.
• Timing of plastic and reconstructive surgery is typically
deferred until weight stability at approximately 1 to 2 years
postoperatively to ensure improved healing.
• For highly selected individuals, and with a well-organized
team, a single-stage total body lift, which includes a
circumferential abdominoplasty, lower body lift, medial
thighplasty, an upper body lift, and breast reshaping, can be
performed safely in under 8 hours
• a hypothesis if body image is improved with corrective
surgery, that weight maintenance in the longer-term may also
be positively affected.
