Centre of Excellence for Metabolic and Bariatric Surgery at Mediclinic Bloemfontein

Bariatric surgery can broadly be defined as surgery of the stomach and intestines. The procedure changes the digestive system, assisting patients with weight loss. The benefits thereof may include:

• Improvements in metabolic and general health
• Cosmetic and aesthetic improvements in appearance
• Improvements in mental wellbeing

The high incidence of obesity has necessitated the establishment of programmes for the management of obesity and associated health complications. According to research, obesity has increased exponentially over the last few years. South Africa has the highest obesity rate in Sub-Saharan Africa, with nearly 70% of women and 39% of men considered overweight.

• High blood pressure
• Diabetes
• Heart disease
• Coronary artery disease
• Some cancers (breast, colon, endometrial, gallbladder, kidney and liver)

If you are a candidate for bariatric surgery, significant weight loss could be achieved and serious illnesses associated with morbid obesity resolved. Patients with severe metabolic diseases such as high blood pressure and arthritis could be good candidates, and said ailments might improve after weight loss surgery. A metabolic procedure can potentially be a curative treatment for some patients with Type 2 diabetes and helps reduce the risk of heart disease and stroke.

Bariatric surgery is a major procedure and you will need to meet certain medical guidelines to qualify for it. These include the following:

• A body mass index (BMI) of 40 or higher
• A BMI of 35 or greater with comorbid health conditions (such as diabetes Type 2, irrespective of weight, hypertension, hyperlipidaemia, osteoarthritis or sleep apnoea)
• Proof that your attempts at dietary weight loss have been ineffective or the ability to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be adhered to for the rest of your life after having bariatric surgery
• Older patients should be considered for surgery after careful assessment of comorbidities, if any

Studies have shown that the procedure prolongs life expectancy due to a reduction of comorbid conditions and rapidly improves the patient’s quality of life in terms of better mobility and emotional wellness. It is important to discuss all the potential benefits and risks with your referring doctor and our team of specialists.

According to The American Society for Metabolic and Bariatric Surgery, the procedure is the most effective and long-lasting treatment for severe obesity, often resulting in significant weight loss and improving, preventing or resolving many related diseases.

Prior to surgery, prospective patients are evaluated by an accredited team of healthcare providers comprising bariatric surgeons, a specialist physician, a psychologist, a dietician and an anaesthetist. Patients are assessed according to their individual health profiles. In some instances, they may also be assessed by a cardiologist and psychiatrist.

Our centre offers two bariatric surgery procedures: a gastric bypass or a gastric sleeve procedure – or a staged procedure of both. A gastric bypass reduces the intake and absorption of food, while a gastric sleeve procedure reduces the size of the stomach and enhances early satiety.

Patients are hospitalised for three to five days and will need to take sick leave for about two weeks. Procedures are performed laparoscopically (that is, using a minimally invasive method), although open surgery might be needed in some cases.

The cost of bariatric surgery is covered by many medical schemes, but only if such procedures are deemed necessary for medical purposes and vital in preserving the health of the member. It is best to communicate directly with your scheme to confirm what cover they provide.

General practitioner

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Patient qualifies for bariatric surgery

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Referred to Dr Streicher (Accredited bariatric surgeon)

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Consult all appropriate healthcare providers

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Documentation to medical aid for approval

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Surgery

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Post-operative care

Patients who undergo bariatric surgery will require lifelong vitamin and calcium supplements and strict medical follow-ups. Permanent lifestyle adjustments will ensure that patients experience the maximum benefits of the surgery and maintain their target weight. In some instances, a plastic or reconstructive surgeon may also be part of the post-operative treatment team. Most patients lose weight for one to two years after surgery but, on average, maintain 50% of their excess weight loss five years thereafter.

Dr Carl Streicher

Mediclinic Bloemfontein

Suite 407

T 051 444 6669

ontvangs@surgery.bfnmcc.co.za

Contact the practice of Dr Carl Streicher to learn more about bariatric surgery and follow the link for more information: https://www.thefutureofhealthcare.co.za/inside-mediclinic-bloemfonteins-bariatric-centre-excellence/

Following surgery, most patients may return to work after one or two weeks. Note that your energy levels will be reduced and some half days may be required as a result; an alternative is to work every second day during your first week back. Your surgeon will provide clear instructions in this regard.

It is best not to exert yourself too soon as it might interfere with your recovery.

Right away! You will be able to take gentle, short walks – even while at the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, ensure that your activities are ‘low impact’ for the first month; thereafter, gradually increase the intensity of your exercises over several weeks. If you swim, note that your wounds must be fully healed before you return to the water.

The general answer to this is yes. Make sure to tell your surgeon and anaesthesiologist about all prior operations, particularly those on your abdomen and pelvis. Many of us forget childhood operations. It is best to avoid surprises!

Sometimes, your surgeon may ask to see the operative report from complicated or unusual procedures, especially those on the oesophagus, stomach or bowels.

It can. Be sure to follow any instructions from your surgeon about managing your diabetes around the time of surgery. Almost everyone with Type 2 diabetes sees vast improvements or even complete remission after surgery. Some studies have even reported improvement in Type 1 diabetes after bariatric procedures.

Yes, but you may need medical clearance from your cardiologist. Bariatric surgery leads to improvement in most problems stemming from heart disease, including:

• High blood pressure
• Cholesterol
• Lipid problems
• Heart enlargement (dilated heart or abnormal thickening)
• Vascular (artery and vein) and coronary (heart artery) disease

During the screening process, be sure to inform your surgeon or nurse of any existing heart conditions. Even those with atrial fibrillation, heart valve replacement, previous stents or heart bypass surgery usually do very well. If you are on blood thinners of any type, expect special instructions just before and after surgery.

Most women are much more fertile after surgery, even with moderate pre-op weight loss. Birth control pills do not work as well in heavy patients and are not very reliable during the time your weight is changing; for this reason, having an intrauterine device (IUD) inserted or using condoms and spermicide during intercourse is recommended. Menstrual periods can be very irregular, and you can get pregnant when you least expect it!

Children born after surgery are at less risk of being affected by obesity later due to the activation of certain genes during fetal growth (look up ‘epigenetics’ for more information). There is also a reduced risk of needing a C-section.

While most patients will have some loose or sagging skin, this is often temporary. Changes will typically occur between six and 18 months after surgery. Your individual appearance will be affected by several factors, including how much weight you lose, your age, your genetics, and whether you exercise or smoke. Generally, loose skin is well hidden by clothing such as compression garments, which can be found online.

Some patients will opt for plastic surgery to remove excess skin. Most surgeons recommend waiting at least 18 months, but you can be evaluated before that.

Some hair loss is common between three and six months following surgery, although it is still unclear as to why this occurs. Even if you take all recommended supplements, hair loss will be observed until the follicles return. Nevertheless, this condition is almost always temporary. Adequate intake of protein, vitamins and minerals will help ensure hair regrowth and avoid longer-term thinning.

You will be expected to take a multivitamin for life. Higher doses of certain vitamins or minerals may also be required, especially iron, calcium and vitamin D. In addition, you will need to go for annual lab checks.

Yes. Most bariatric surgeons put their patients on a special pre-operative diet, usually two or three weeks before surgery. The reason for this is to shrink the liver and reduce fat in the abdomen, which helps during the procedure and makes it safer.

Yes and no.

Most people think of a ‘diet’ as an eating plan that leaves you hungry. After undergoing the procedure, however, many patients are unlikely to have an appetite until six to 18 months thereafter. Note that your appetite will also be weaker, albeit easier to satisfy than before.

This does not mean that you can eat whatever and whenever you want. Healthier food choices are essential for best results. That said, most patients are still able to enjoy tasty food – even ‘treats’.

A variety of activities can work for you. There is no ‘one size fits all’ plan. Expect to learn and change as you go!

For many patients (and people with normal body weight), exercise is more important for regular stress management and appetite control than simply burning off calories. As we age, inactivity can result in frailty or fragility, which poses a considerable threat to one’s overall health. To ensure healthy bones and prevent muscle loss, it is best to engage in weekly weight-bearing (including walking) or muscle resistance (weights or similar) exercises.

Almost everyone is able to find some activity that qualifies as moderate exercise – even those who are partially paralysed, have arthritis or experience joint replacement or spinal pain. Special therapists may be needed to help determine what works for you.

As you lose weight, it may become possible to reduce or eliminate many of the medications you take for high blood pressure, heart disease, arthritis, cholesterol and diabetes. If you have had a gastric bypass or sleeve gastrectomy, you may even be able to lessen the dosage or discontinue your diabetes medication soon after your procedure.