Current Selection Criteria For Bariatric Surgery:

Age 18-55

BMI 35 with a co-morbidity of 40 or over.

No alcohol or drug dependence.

No delusional or psychotic illness.

Agreement to life-long follow up.

The first step in the selection process is to ask if the patient is likely to benefit from weight loss. Is compliance realistic and is the patient fit enough to tolerate the procedure?

Sufficient evidence is now available that most obesity related illnesses respond to weight loss. In a recent review, there was significant improvement of diabetes in over 75% of patients after bariatric (weight loss) procedures. Even 20% loss of excess weight (EWL) can lead to a halving of diabetic risk, while hypertension, progression and risk of ischaemic heart disease and musculoskeletal pain with limitation of activity are all reduced in severity and prevalence. Depression, which is often a consequence of obesity, responds to weight loss and quality of life is improved, while there is resolution of sleep apnoea in 87% of patients after weight loss.

Some behavioural patterns predict a better outcome. A past history of success at weight loss is a good sign of motivation and is associated with a greater likelihood of success, while patients who have lost weight in the immediate pre - operative period are more likely to have a better long term weight loss. Pre - existing depression does not lead to a worse outcome and is not an exclusion criterion.

Contraindications to bariatric surgery are a lack of capacity to comply with a follow up programme such as in patients with severe cognitive or mental retardation, severe eating disorders unresponsive to psychotherapy and pharmacological treatment, and medical conditions such as autoimmune disorders or oesophageal varices.

Age

In those over 55 gastric banding and other bariatric procedures seem to be almost as effective as in younger age groups. Mr Hashemi has performed bariatric surgery in patients up to 67 years of age. However, obesity related morbidities are often established and less reversible in the older patient and the key to success is careful selection, risk assessment and planning.

Procedures (click to view)

Majid Hashemi specialises in Laparoscopic Bariatric Surgery to achieve long term weight loss - the safe surgery option for overweight and obese patients.

Mr Hashemi has been performing laparoscopic bariatric surgery since 2001 and was among the first surgeons in the UK to establish a tertiary referral and dedicated multidisciplinary service in obesity surgery. As well as surgery for obesity, he regularly performs other complex laparoscopic operations for the repair of hiatus hernias, for the treatment of reflux disease and for achalasia.