According to the SAGES criteria of international authorities in laparoscopic surgery, there is no absolute contraindication for obesity surgeon. Relative contraindications are patients with severe cardiac insufficiency, unstable coronary heart disease, end stage lung disease, active cancer diagnosis, cirrhosis with portal hypertension, uncontrolled drug or alcohol dependence, and impaired cognitive capacity at advanced stages. Crohn’s disease may be a relative contraindication for operations involving bypass.
However, laparoscopic surgery can be very difficult or impossible in patients with giant abdominal hernias, in patients with advanced intraabdominal adhesions, in patients with very large and fatty liver, or when the abdominal filling of the abdomen can not be tolerated.
In the case of super morbid obese patients where the operation is at a higher risk, or in the case of severe comorbid disease, it is a good strategy to take an amelia after an operation without an operation like a pre-operative gastric balloon and after a certain weight loss of the patient with dietary support.
The age limit on surgery has lost its former significance due to the development of anesthesia techniques. Of course, a lower weight loss expectation may include a lower rate of decline in co-morbid illness, a longer length of stay, a higher risk of mortality and morbidity, but patients aged 60 years or older may also be taken to obesity surgery with good preparation.