Multidisciplinary Perioperative Care for Bariatric Surgery: Radiologic Assessment, Operating Room Practice, Nutritional Optimization, Nursing Care, Optometric Screening, and Social Work Support
Abstract
Background: Morbid obesity is a chronic, multisystem disease associated with over 200 comorbidities, including diabetes, hypertension, and obstructive sleep apnea. Bariatric surgery remains the gold standard for sustained weight loss and metabolic improvement despite advances in pharmacotherapy.
Aim: To review multidisciplinary perioperative care for bariatric surgery, emphasizing radiologic assessment, operative practices, nutritional optimization, nursing care, optometric screening, and psychosocial support.
Methods: A comprehensive narrative synthesis of current evidence and clinical guidelines was conducted, focusing on surgical techniques, functional mechanisms, complication profiles, and team-based interventions.
Results: Bariatric procedures such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass achieve 30–40% weight loss and high rates of comorbidity resolution. However, complications—including hemorrhage (0.6–2.7%), leaks (0.3–3%), internal hernias, marginal ulcers, reflux, thromboembolism, and nutritional deficiencies—require vigilant monitoring. Multidisciplinary strategies integrating radiology, nursing surveillance, dietetics, mental health, and social work significantly reduce morbidity and improve long-term outcomes. Emerging pharmacologic agents (GLP-1/GIP agonists) complement surgical care but face cost and access barriers.
Conclusion: Bariatric surgery is a metabolic intervention requiring structured, longitudinal, and team-based care to optimize safety and durability. Effective outcomes depend on early complication recognition, nutritional management, psychosocial support, and coordinated follow-up.
Full text article
References
Moll H, Frey E, Gerber P, Geidl B, Kaufmann M, Braun J, Beuschlein F, Puhan MA, Yebyo HG. GLP-1 receptor agonists for weight reduction in people living with obesity but without diabetes: a living benefit-harm modelling study. EClinicalMedicine. 2024 Jul:73():102661. doi: 10.1016/j.eclinm.2024.102661.
Norain A, Arafat M, Burjonrappa S. Trending Weight Loss Patterns in Obese and Super Obese Adolescents: Does Laparoscopic Sleeve Gastrectomy Provide Equivalent Outcomes in both Groups? Obesity surgery. 2019 Aug:29(8):2511-2516. doi: 10.1007/s11695-019-03867-8.
Hsu JL, Ismail S, Hodges MM, Agala CB, Farrell TM. Bariatric surgery: trends in utilization, complications, conversions and revisions. Surgical endoscopy. 2024 Aug:38(8):4613-4623. doi: 10.1007/s00464-024-10985-7.
Kollmann L, Gruber M, Lock JF, Germer CT, Seyfried F. Clinical Management of Major Postoperative Bleeding After Bariatric Surgery. Obesity surgery. 2024 Mar:34(3):751-759. doi: 10.1007/s11695-023-07040-0.
Douros JD, Tong J, D'Alessio DA. The Effects of Bariatric Surgery on Islet Function, Insulin Secretion, and Glucose Control. Endocrine reviews. 2019 Oct 1:40(5):1394-1423. doi: 10.1210/er.2018-00183.
Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nature reviews. Gastroenterology & hepatology. 2017 Mar:14(3):160-169. doi: 10.1038/nrgastro.2016.170.
Gastaldelli A, Iaconelli A, Gaggini M, Magnone MC, Veneziani A, Rubino F, Mingrone G. Short-term Effects of Laparoscopic Adjustable Gastric Banding Versus Roux-en-Y Gastric Bypass. Diabetes care. 2016 Nov:39(11):1925-1931
Guzman-Pruneda FA, Brethauer SA. Gastroesophageal Reflux After Sleeve Gastrectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2021 Feb:25(2):542-550. doi: 10.1007/s11605-020-04786-1
Tomasicchio G, D'abramo FS, Dibra R, Trigiante G, Picciariello A, Dezi A, Rotelli MT, Ranaldo N, Di Leo A, Martines G. Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction? Surgery. 2022 Sep:172(3):807-812. doi: 10.1016/j.surg.2022.04.040.
Anderson B, Switzer NJ, Almamar A, Shi X, Birch DW, Karmali S. The impact of laparoscopic sleeve gastrectomy on plasma ghrelin levels: a systematic review. Obesity surgery. 2013 Sep:23(9):1476-80. doi: 10.1007/s11695-013-0999-7.
Kwon Y, Lee S, Kim D, ALRomi A, Park SH, Lee CM, Kim JH, Park S. Biliopancreatic Limb Length as a Potential Key Factor in Superior Glycemic Outcomes After Roux-en-Y Gastric Bypass in Patients With Type 2 Diabetes: A Meta-Analysis. Diabetes care. 2022 Dec 1:45(12):3091-3100. doi: 10.2337/dc22-0835.
Buser A, Joray C, Schiavon M, Kosinski C, Minder B, Nakas CT, Man CD, Muka T, Herzig D, Bally L. Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on β-Cell Function at 1 Year After Surgery: A Systematic Review. The Journal of clinical endocrinology and metabolism. 2022 Nov 23:107(11):3182-3197. doi: 10.1210/clinem/dgac446.
Ali AB, Morris LM, Hodges J, Amirkhosravi F, Yasrebi S, Khoo A, Graviss EA, Nguyen DT, Reardon PR. Postoperative bleeding and leaks in sleeve gastrectomy are independent of both staple height and staple line oversewing. Surgical endoscopy. 2022 Sep:36(9):6924-6930. doi: 10.1007/s00464-022-09031-1.
Odovic M, Clerc D, Demartines N, Suter M. Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management - a 21-Year Experience. Obesity surgery. 2022 Oct:32(10):3232-3238. doi: 10.1007/s11695-022-06173-y.
Straatman J, Verhaak T, Demirkiran A, Harlaar NJ, Cense HA, Jonker FHW, Dutch Audit for Treatment of Obesity (DATO) Research Group. Risk factors for postoperative bleeding in bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2022 Aug:18(8):1057-1065. doi: 10.1016/j.soard.2022.05.010.
Bashah M, Khidir N, El-Matbouly M. Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution. Obesity surgery. 2020 Feb:30(2):515-520. doi: 10.1007/s11695-019-04203-w.
Vidarsson B, Sundbom M, Edholm D. Incidence and treatment of small bowel leak after Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2020 Aug:16(8):1005-1010. doi: 10.1016/j.soard.2020.04.013.
Mocanu V, Dang J, Ladak F, Switzer N, Birch DW, Karmali S. Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2019 Mar:15(3):396-403. doi: 10.1016/j.soard.2019.01.012.
Dayma K, David A, Omer A, Abdel-Dayam H, Tawil A, Socci N, Ahmed L, Gilet A, Haddad D. Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility. Obesity surgery. 2024 May:34(5):1552-1560. doi: 10.1007/s11695-024-07125-4.
Coşkun M, Uprak TK, Günal Ö, Aliyeva A, Cingi A. Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective? Surgical laparoscopy, endoscopy & percutaneous techniques. 2024 Jun 1:34(3):290-294. doi: 10.1097/SLE.0000000000001283.
Abu-Abeid A, Litmanovich A, Abu-Abeid S, Eldar SM, Lahat G, Yuval JB. Long-Term Outcomes of Patients with Staple Line Leaks Following Sleeve Gastrectomy. Obesity surgery. 2024 Jul:34(7):2523-2529. doi: 10.1007/s11695-024-07307-0.
Garza E Jr, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T. Internal hernias after laparoscopic Roux-en-Y gastric bypass. American journal of surgery. 2004 Dec:188(6):796-800
El Nogoomi I, Nouh AK, Jaber AA, Toubah AM, Alkaram SS. Petersen's Hernia After Roux-en-Y Gastric Bypass: A Case Report. Cureus. 2023 Dec:15(12):e50757. doi: 10.7759/cureus.50757.
Martinino A, Bhandari M, Abouelazayem M, Abdellatif A, Koshy RM, Mahawar K. Perforated marginal ulcer after gastric bypass for obesity: a systematic review. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2022 Sep:18(9):1168-1175. doi: 10.1016/j.soard.2022.05.024.
Salame M, Jawhar N, Belluzzi A, Al-Kordi M, Storm AC, Abu Dayyeh BK, Ghanem OM. Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management. Journal of clinical medicine. 2023 Jun 28:12(13):. doi: 10.3390/jcm12134336.
Goel R, Nasta AM, Goel M, Prasad A, Jammu G, Fobi M, Ismail M, Raj P, Palaniappan R, Aggarwal S, Bindal V, Katakwar A, Vennapusa A, Bhasker AG, Peters A, Goel D, Bedi D, Palep J, Kona L, Mehrotra M, Baijal M, Bhandari M, Dukkipati N, Wadhawan R, Baig S, Pattanshetti S, Ugale S. Complications after bariatric surgery: A multicentric study of 11,568 patients from Indian bariatric surgery outcomes reporting group. Journal of minimal access surgery. 2021 Apr-Jun:17(2):213-220. doi: 10.4103/jmas.JMAS_12_20.
Carvalho L, Almeida RF, Nora M, Guimarães M. Thromboembolic Complications After Bariatric Surgery: Is the High Risk Real? Cureus. 2023 Jan:15(1):e33444. doi: 10.7759/cureus.33444.
Samigullin A, Weihrauch J, Otto M, Rech A, Buchenberger S, Morcos M, Humpert PM. Postprandial Symptoms in a Mixed-Meal-Test after Bariatric Surgery: Clinical Experience and a Critical Review of Dumping Syndrome Definition and Management. Obesity facts. 2025:18(1):31-38. doi: 10.1159/000541780.
Langan RC, Zawistoski KJ. Update on vitamin B12 deficiency. American family physician. 2011 Jun 15:83(12):1425-30
Shahmiri SS, Eghbali F, Ismaeil A, Gholizadeh B, Khalooeifard R, Valizadeh R, Rokhgireh S, Kermansaravi M. Selenium Deficiency After Bariatric Surgery, Incidence and Symptoms: a Systematic Review and Meta-Analysis. Obesity surgery. 2022 May:32(5):1719-1725. doi: 10.1007/s11695-022-05932-1.
Lewis CA, de Jersey S, Seymour M, Hopkins G, Hickman I, Osland E. Iron, Vitamin B(12), Folate and Copper Deficiency After Bariatric Surgery and the Impact on Anaemia: a Systematic Review. Obesity surgery. 2020 Nov:30(11):4542-4591. doi: 10.1007/s11695-020-04872-y.
Enani G, Bilgic E, Lebedeva E, Delisle M, Vergis A, Hardy K. The incidence of iron deficiency anemia post-Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review. Surgical endoscopy. 2020 Jul:34(7):3002-3010. doi: 10.1007/s00464-019-07092-3.
Cohen Vig L, Straussberg R, Ziv N, Hirschfeld-Dicker L, Konen O, Aharoni S. Neurologic complications of thiamine (B1) deficiency following bariatric surgery in adolescents. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society. 2024 May:50():74-80. doi: 10.1016/j.ejpn.2024.04.008.
Gerges WB, Omar ASM, Shoka AA, Hamed MA, Abdelrahim HS, Makram F. ReSleeve or revisional one anastomosis gastric bypass for failed primary sleeve gastrectomy with dilated gastric tube: a retrospective study. Surgical endoscopy. 2024 Feb:38(2):787-798. doi: 10.1007/s00464-023-10609-6.
Brunaldi VO, Jirapinyo P, de Moura DTH, Okazaki O, Bernardo WM, Galvão Neto M, Campos JM, Santo MA, de Moura EGH. Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis. Obesity surgery. 2018 Jan:28(1):266-276. doi: 10.1007/s11695-017-2986-x.
Michalsky MP, Inge TH, Jenkins TM, Xie C, Courcoulas A, Helmrath M, Brandt ML, Harmon CM, Chen M, Dixon JB, Urbina EM, Teen-LABS Consortium. Cardiovascular Risk Factors After Adolescent Bariatric Surgery. Pediatrics. 2018 Feb:141(2):. doi: 10.1542/peds.2017-2485.
Roth CL, Scimia C, Shoemaker AH, Gottschalk M, Miller J, Yuan G, Malhotra S, Abuzzahab MJ. Setmelanotide for the treatment of acquired hypothalamic obesity: a phase 2, open-label, multicentre trial. The lancet. Diabetes & endocrinology. 2024 Jun:12(6):380-389. doi: 10.1016/S2213-8587(24)00087-1.
Bullen NL, Parmar J, Gilbert J, Clarke M, Cota A, Finlay IG. How Effective Is the Multidisciplinary Team Approach in Bariatric Surgery? Obesity surgery. 2019 Oct:29(10):3232-3238. doi: 10.1007/s11695-019-03975-5.
Houlden RL, Yen JL, Moore S. Effectiveness of an Interprofessional Glycemic Optimization Clinic on Preoperative Glycated Hemoglobin Levels for Adult Patients With Type 2 Diabetes Undergoing Bariatric Surgery. Canadian journal of diabetes. 2018 Oct:42(5):514-519. doi: 10.1016/j.jcjd.2017.12.011.
Fox W, Borgert A, Rasmussen C, Kallies K, Klas P, Kothari S. Long-term micronutrient surveillance after gastric bypass surgery in an integrated healthcare system. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2019 Mar:15(3):389-395. doi: 10.1016/j.soard.2018.12.029.
Authors
Copyright (c) 2025 Jamilah Matuq Aljuaidan, Ghazi Nasser Alotibi, Abdullah Ibrahim Aldubaikhi, Adnan Abdullah Alhussain, Modhi Mfadhi Alanazi, Basmah Abdulaziz Nasser Alsulaiman, Alfadhel Yahya Alshafie, Mohammed Abdu Mohammed Hindi, Norah Abdu Ahmed Zailay, Gaissi Hassan Abdu H, Hussain Mohammed Hussain Khared, Othman Mohammed Ahmed Mahzary, Mateb Hussain Muklif Alanazi, Riyadh Mohammed Hussain Khared, Aeshah Taleb Albaeji
This work is licensed under a Creative Commons Attribution 4.0 International License.