The ASMBS therefore recognizes SG as an acceptable option as a primary bariatric procedure and as a first-stage procedure in high-risk patients as part of a planned staged approach.

Based on the current published literature, SG has a risk/benefit profile that lies between the laparoscopic adjustable gastric band and the laparoscopic Roux-en-Y gastric bypass.

As with any bariatric procedure, long-term weight regain can occur, and, in the case of SG, this could be managed effectively with re-intervention. Informed consent for SG used as a primary procedure should be consistent with consent provided for other bariatric procedures and should include the risk of long-term weight gain.

OSA is highly prevalent in the bariatric patient population. The high prevalence demonstrated in some studies suggests that consideration be given to testing all patients, and especially those with any preoperative symptoms suggesting obstructive sleep apnea.

Untreated OSA is yet another comorbidity observed with high prevalence in the bariatric patient population that leads to increased mortality and increased medical disability from several cardiovascular diseases. These observations further emphasize the value of bariatric surgery as a potentially definitive treatment for OSA in severely obese patients.

Patients who have documented moderate to severe OSA should be strongly encouraged to accept treatment preoperatively with continuous positive airway pressure (CPAP) and to use it postoperatively until clinical evaluation demonstrates resolution of OSA.

These patients should also bring their CPAP machines, or at least their masks, with them at the time of surgery and use them following bariatric surgery at the discretion of the surgeon.

All commonly performed bariatric operations that have been assessed for the impact on OSA have shown evidence for significant relief of subjective symptoms of OSA and improvement of objective parameters of OSA that may not always correlate with the amount of weight lost.

Since bariatric surgery produces many improvements in the quality of life and other coexisting medical conditions for severely obese patients with OSA, it should be considered as the initial treatment of choice for OSA in this patient population as opposed to surgical procedures directed at the mandible or tissues of the palate.

Routine pulse oximetry or capnography for postoperative monitoring of patients with OSA after bariatric surgery should be utilized, but the majority of these patients do not routinely require an ICU setting.

No clear guidelines exist upon which to base recommendations for retesting for OSA following bariatric surgery. However, a strong consideration should be given to retesting patients who present years after bariatric surgery with regain of weight, a history of previous OSA, and who are being reevaluated for appropriate medical and potential reoperative surgical therapy.

Based on the unique characteristics of the bariatric patient, the potential for major early and late complications after bariatric procedures, the specific follow-up requirements for different bariatric procedures, and the nature of treating the chronic disease of obesity, extensive travel to undergo bariatric surgery should be discouraged unless appropriate follow-up and continuity of care are arranged and transfer of medical information is adequate.

The ASMBS opposes mandatory referral across international borders or long distances by insurance companies for patients requesting bariatric surgery if a high-quality bariatric program is available locally.

The ASMBS opposes the creation of financial incentives or disincentives by insurance companies or employers that limit patients’ choices of bariatric surgery location or surgical options and, in effect, make medical tourism the only financially viable option for patients.

The ASMBS recognizes the right of individuals to pursue medical care at the facility of their choice. Should they choose to undergo bariatric surgery as part of a medical tourism package or pursue bariatric surgery at a facility a long distance from their home, the following guidelines are recommended:

When a patient who has had a bariatric procedure at a distant facility presents with an emergent life-threatening postoperative complication, the local bariatric surgeon on call should provide appropriate care to the patient consistent with the established standard of care and in keeping with ethical guidelines of the ASMBS. This care should be provided without risk of litigation for complications or long-term sequelae resulting from the initial procedure performed abroad. Routine or non-emergent care for patients who have had bariatric surgery elsewhere should be provided at the discretion of the local bariatric surgeon.