Surgeons must weigh the risks of operating on patients with severe heart failure or coronary artery disease against the long-term benefits of metabolic improvement.

A debated topic is whether mandatory weight loss before surgery accurately predicts long-term success. Procedural Selection:

A significant focus is placed on , which occurs in up to 30% of cases. Decisions involve whether to perform revisional surgery or utilize endoscopic procedures like transoral outlet reduction (eTOR) . Ethical and Social Considerations Difficult Decisions in Bariatric Surgery | Request PDF

Newer controversies include the comparative efficacy of single-stage vs. two-stage duodenal switches.