Bariatric surgery is a highly specialized field of obesity management. Other surgical and medical disciplines and practitioners are not always best informed in this rapidly evolving field.
With my ongoing interest in obesity and the diseases related to obesity, together with my surgical knowledge, I have specialised in bariatric surgery and I work alongside Professor Tessa van der Merwe and Dr Gary Fetter at the Bariatric Centre of Excellence in the Waterfall City Hospital, Midrand, Johannesburg. This is the head office for CEMMS (Centres of Excellence for Metabolic Medicine and Surgey) and we have obtained full international accreditation.
If you are considering bariatric surgery and require more information about bariatric surgery in South Africa and CEMMS accredited centers please see www.sasomonline.co.za. Accredited centers work closely with the medical aids who will help fund some of the surgery.
Criteria for the selection of obese patients for surgery
- Pt’s at a BMI > 40
- Pt’s at a BMI > 35 with co-morbid diseases eg cardiovascular disease, type 2 diabetes, sleep apnea, HTN
- Pt’s at a BMI >30 with poorly controlled diabetes mellitus
- Acceptable operative risks
- A well-informed and motivated patient
- Commitment to change
- Family and or partner support
- Any member of the team can voice concern about the inclusion for surgery. However, the final decision is the physician’s.
Types of Surgery
- Pts with a BMI < 49
- GBP is predominantly restrictive procedure with a longer Roux limb (> 150cm) adding to the procedure a malabsorptive component
- No part of the intestine is removed therefore it can be reversed
- Hormonal changes occur in the bypassed stomach and duodenum that in turn regulate the appetite and satiety centers of the brain.
- Hospital stay 2 nights
- Pts with BMI > 50
- Both a restrictive and malabsorptive procedure
- Bypasses a portion of the intestine resulting in more malabsorption than GBP
- More side effects if diet is not followed – dumping, diarrhoea, smelly stools
- Hospital stay 5 nights
It is important to remember the nutritional aspects and dietary progression pre and post bariatric surgery differs between centres and from country to country. It is therefore important to follow the dietary recommendations given to you by your dietitian.
Your dietitian visits are of the utmost importance:
- Pre-operative consultations aim to ensure any existing nutritional deficiencies are addressed and to ensure you are getting into good healthy eating and lifestyle behaviours prior to your surgery.
- Pre and post operative dietary progression.
- Post-operative consultations are necessary to ensure an optimal nutritional status; promote wound healing; preserve lean muscle mass; facilitate safe and sustained weight loss; and nurture a healthier lifestyle.
- Annual follow ups are of high importance to ensure you continue in your healthy eating behaviours and have achieved the weight loss recommended. If you are non compliant with the post operative dietary recommendations, you can start to regain weight and your macronutrient (protein) and micronutrient (vitamins and minerals) stores can become progressively depleted. Only once the levels are dangerously low, will you start to experience feelings of sub-optimal performance.