Gastric sleeve surgery, formally known as sleeve gastrectomy, is a restrictive weight-loss procedure where approximately 80% of the stomach is surgically removed, creating a smaller, tube-shaped stomach pouch. This procedure requires a rigorous and mandatory pre-operative testing process. This extensive evaluation ensures the patient is physically safe for the operation and anesthesia, mentally prepared for the profound lifestyle changes required, and meets the strict criteria set by insurance providers for coverage and long-term success.
Baseline Medical and Lab Testing
The initial phase involves standard laboratory tests to establish a baseline of the patient’s general health status. A Complete Blood Count (CBC) screens for signs of anemia, infection, or other abnormalities that could complicate surgery and recovery. The Comprehensive Metabolic Panel (CMP) assesses kidney and liver function, electrolyte balance, and blood glucose control, providing a profile of metabolic health.
Screenings are conducted for nutritional deficiencies common in bariatric patients, which may worsen after the procedure due to reduced food intake and altered absorption. This includes testing for Vitamin B12, Vitamin D, and iron stores (ferritin) to ensure levels are optimized before surgery. Thyroid function tests, measuring Thyroid-Stimulating Hormone (TSH), rule out untreated hypothyroidism, a condition that can hinder post-operative weight loss. Urine analysis checks for kidney issues or signs of undiagnosed diabetes.
Gastrointestinal and Cardiovascular Assessments
Evaluation of the gastrointestinal tract is mandatory, particularly the Upper Endoscopy (EGD). This procedure involves inserting a flexible tube with a camera to visually inspect the internal lining of the upper digestive system for pre-existing conditions. Finding a hiatal hernia, ulcers, or significant inflammation (esophagitis) may delay the procedure or require a change in the surgical plan.
During the EGD, the surgical team looks for Helicobacter pylori (H. pylori) bacteria, which must be eradicated with antibiotics before surgery to prevent post-operative complications at the staple line. Cardiovascular assessments are important, given the increased risk of heart issues in patients with high body mass index. An Electrocardiogram (EKG/ECG) is standard to evaluate the heart’s electrical activity. An echocardiogram or stress test may be requested for high-risk patients to ensure the heart can withstand the stress of anesthesia and surgery.
Pulmonary clearance is a component of the assessment, especially for patients with a history of Obstructive Sleep Apnea (OSA). A Chest X-ray and Pulmonary Function Tests (PFTs) determine the overall health and capacity of the lungs. Respiratory complications are a concern during and after general anesthesia in patients with obesity. Addressing pulmonary issues beforehand, such as optimizing continuous positive airway pressure (CPAP) use, is necessary for surgical clearance and safe recovery.
Psychological and Nutritional Readiness
Beyond physical checks, the preparation phase emphasizes the patient’s psychological and behavioral readiness for the permanent lifestyle transformation. A comprehensive psychological evaluation assesses for untreated mental health conditions, such as severe depression, active substance abuse, or uncontrolled eating disorders like binge eating. The purpose is to identify issues that could sabotage long-term success and ensure they are managed before the operation.
The psychological screening evaluates the patient’s motivation, the presence of a strong support system, and whether expectations for post-operative life are realistic. The evaluator determines the patient’s capacity to adhere to the strict, lifelong dietary and exercise rules necessary to maintain weight loss. This assessment establishes that the patient possesses the behavioral discipline and emotional stability required to navigate the profound physical and social changes that occur after the procedure.
Nutritional counseling is the other half of the readiness phase, involving mandatory sessions with a registered dietitian. These sessions educate the patient on the differences between pre-operative and post-operative dietary requirements. Patients learn about the necessary pre-op diet, which often includes a liquid phase designed to reduce liver size and improve surgical access. The focus is on teaching the patient about reduced portion sizes, protein prioritization, and the permanent requirement for specific nutritional supplements to prevent deficiencies.