KUWAIT CITY, Aug 11: Minister of Health Dr. Ahmed Al-Awadi issued Ministerial Decree No. 221/2026 on the requirements, regulations and standards for performing bariatric surgeries and non-surgical interventional procedures in healthcare facilities in the public and private sectors.
The decree defines the scope of bariatric and metabolic surgeries, classifying them into primary, reconstructive and malabsorption procedures. It regulates non-surgical interventional procedures, including endoscopic sleeve gastrectomy (ESG) and gastric balloon (IGB), specifying the requirements and standards for each category. The decree establishes clear criteria for conducting primary bariatric surgery.
It recommends surgery for patients with a body mass index (BMI) of 35 kg/m² or higher. Patients with a BMI between 30 and 34.9 kg/m² who also have at least one obesity-related comorbidity could be considered. The decree recommends exploring non-surgical treatment options before considering surgical intervention.
It specifies the primary surgical procedures, including sleeve gastrectomy, classic gastric bypass, mini-gastric bypass and gastric banding. It stipulates that there is no fixed upper age limit for bariatric surgery, as the decision depends on the overall health condition of the patient. It authorizes the consideration of bariatric surgery for selected cases of children and adolescents aged 12 to 17, according to certain criteria, after a comprehensive evaluation and approval by a multidisciplinary team (MDT), and obtaining written informed consent from the parents or legal guardians.
It requires medical follow up for a minimum of two years after the procedure. It specifies the criteria for body mass index and comorbidity for this age group, limiting the recommended procedures to sleeve gastrectomy and gastric bypass in specific cases. It also regulates reconstructive and malabsorption surgeries, specifying the cases in which reconstructive surgery may be considered. These cases include weight regain or insufficient weight loss after the previous bariatric surgery, failure to achieve adequate improvement in comorbidity, and the treatment of certain complications, such as severe gastroesophageal reflux disease (GERD).
It stipulates that reconstructive and malabsorption surgeries must be reviewed by a multidisciplinary team, and their official and documented approval must be obtained before the surgery. It prohibits malabsorption surgery as a primary procedure and that it should be performed only by an experienced surgeon with proven expertise in such procedures.
It regulates non-surgical interventional bariatric procedures, specifying laparoscopic sleeve gastrectomy and gastric balloon placement within this category. It states the criteria, including body mass index (BMI) of 27 kg/m or higher as a primary weight loss option, or 50 kg/m or higher as preliminary treatment before the final surgery. The surgery must be performed by a qualified bariatric surgeon or a certified gastroenterologist trained in laparoscopic bariatric procedures.
This surgery is not permitted for patients below 18 years old. It restricts conducting bariatric surgeries to government hospitals or licensed and qualified private hospitals. It states that private hospitals must have suitable infrastructure, including intensive care units, medical imaging services and laboratory services, along with comprehensive pre-operative assessment protocols. It mandates the immediate reporting of serious complications classified as level three or higher according to the Clavien-Dindo classification, as well as deaths, and establishes specific reporting pathways in both the public and private sectors.
By Marwa Al-Bahrawi Al-Seyassah/Arab Times Staff
