According to the criteria determined by SAGES , one of the international authorities in the field of laparoscopic surgery, there is no absolute contraindication for bariatric surgery. Relative contraindications, i.e. inoperable cases are severe heart failure, non-stable coronary heart disease, end-stage lung disease, diagnosis of active cancer, cirrhosis accompanied by portal hypertension, uncontrolled drug or alcohol addiction, and severely deteriorated cognitive capacity. Crohn’s disease may be a relative contraindication for surgical operations that involve bypass. According to the recommendations of companies, it is also a contraindication for gastric band.
Besides these, laparoscopic surgery can be very difficult or impossible when performed in patients with giant abdominal hernia, patients with severe intra-abdominal adhesions, patients with very large and fatty liver, and in cases where inflation of the abdomen with gas cannot be tolerated. Therefore, laparoscopic surgeons should have the experience to perform the same operation as an open surgery as well. It is because in every laparoscopic surgery, there is a risk (even if a minor risk) of returning to open surgery. This is not a complication, but a compulsory surgical decision taken for patient safety. However, it is definitely inappropriate to perform an open bariatric surgery as the first option. A surgeon who cannot perform laparoscopic bariatric surgery cannot be a bariatric surgeon.
It is a good strategy to operate the patient after enabling him/her to lose weight to a certain extent with non-surgical methods such as placing a intragastric balloon and dietary supports in super morbid obese patients, for whom surgery poses a high risk, or patients with severe comorbidities. The issue of age limit for surgical operations has lost its importance, as a result of the development of anesthesia techniques. Of course it involves the expectation of a lower weight loss rate, lower regression rate of comorbidities, longer length of hospitalization durations, higher mortality and morbidity risks; but after a good preparation, patient aged 60 years and older can be treated with bariatric surgery as well.
At the US National Consensus conference held in 1991, bariatric surgery was not advised to be performed in obese children and adolescents, due to inadequate data. However, pediatric bariatric surgery arouses more interest with each passing day. In 10-year follow-up studies on obese children under 18 years of age, bypass surgery has shown to provide perfect weight loss and be well-tolerated. According to specialists believing that the age limit should be below 18, normal weight should be restored at an early age, to prevent physical and emotional destruction that may be caused by obesity. Many well-designed studies are being conducted to well-identify the position of adolescent bariatric surgery.