For Referring Providers - Does My Patient Qualify?

Thank you for referring your patients for consideration for Bariatric Surgery at Fletcher Allen. Referrals can be made by downloading and completing the referral letter. Please fax the completed letter to us at (802) 847-0733. Your patient will either be sent a Health Questionnaire to fill out and return OR they can download a questionnaire, complete and mail or fax to us.

Determining Eligibility for Bariatric Surgery

General Qualifications

Fletcher Allen follows NIH standards in determining whether a patient meets the criteria for Bariatric Surgery.

a) Determine BMI

Patients must have a BMI >40 OR >35 with significant co-morbidity

Significant co-morbidity includes but is not limited to: Diabetes, Hypertension, Obstructive Sleep Apnea, at the surgeon's discretion.

b) Age greater than 18.  

c) History of documented repeated failure of non-surgical weight loss attempts.

d) Candidate must have realistic expectations, be motivated and able to conform to the strict post-op dietary and exercise recommendations, and demonstrate a commitment to succeed by attending all scheduled appointments.

Absolute Contraindications

Patients are not eligible for any Bariatric Surgery at Fletcher Allen if:

a) Significant psychological issues exist. These patients may require follow-up with a psychiatrist or psychologist before consideration for surgery: Recent suicide attempt or suicidal ideation requiring hospitalization within the past 2 years. Untreated or uncontrolled mental illness (bipolar, schizophrenia, dissociative identity disorder, etc).         

b)  History of malignancy or recurrence of malignant disorder within 2 years

c)  Connective tissue disease (Sjogren's, lupus, scleroderma, etc.)

d)  Multiple Sclerosis

e)  Barrett's Esophagitis with severe dysplasia

f)   Substance Abuse within 2 years

Relative Contraindications

Patients may be ineligible for Bariatric Surgery if:

a)  Recent history of anorexia or bulimia

b)  Cirrhosis with severe, uncontrolled portal hypertension

c)  Unstable living situation, such as homelessness

d)  Significant developmental delay or cognitive impairment

Determining Which Surgery is Best for Your Patient

The Bariatric Surgery team and the patient mutually decide upon the type of surgery performed. However, some general guidelines are listed below.

NOTE: Significant abdominal adhesions from prior surgeries, such as open cholecystecomy, hernia repair, etc, may interfere with any of the laparoscopic procedures including band, bypass and gastric sleeve.

Patients may be suitable for Gastric Banding/Laparoscopic Adjustable Gastric Band if:

1. BMI 50 or less or willing to lose enough weight pre-surgically to be in that range (individual BMI goal is set by the surgeon)

2. There are no existing gastric or esophageal disorders such as esophageal dysmotility, Nissan fundoplication, etc.

3. Able to exercise a minimum of 150 minutes per week

4. Successful weight loss with diet and exercise in the past

Gastric Sleeve/Sleeve Gastrectomy may be indicated if:

1. BMI low 50'

2. Organ transplant or impending transplant

3. Fear of implanted medical device

4. Feels bypass is too medically risky

5. Needs quicker weight loss for resolution of medical issues (expected rate of weight loss is between band and bypass)

Gastric Bypass (Roux-en-Y-Gastric Bypass) criteria:

1. BMI low 50's for laparoscopic bypass. Higher BMI's indicate need for open bypass.

2. Significant life-threatening medical problems requiring quick weight loss for resolution

3. Fastest and most effective resolution of Diabetes Type 2

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