Which of the following is/are contraindications to gastric bypass surgery?

D. Failure to agree to long-term follow-up.

DISCUSSION: The gastric bypass represents the best known therapy for diabetes mellitus, hypertension, the Pickwickian syndrome, and sleep apnea. In fact, no other therapy provides such complete control of hyperglycemia and hyperinsulinemia, reversal of hypertension, and total correction of the Pickwickian syndrome and most cases of sleep apnea. The only contraindication to bariatric surgery listed is failure to agree to long-term follow-up. The gastric bypass represents controlled malnutrition and, therefore, vitamin therapy is especially important. If patients are not followed closely, vitamin deficiencies, especially of B 6 and B 12, can develop with serious consequences including a Korsakoff-Wernicke syndrome.