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Bariatric facilities and services

What is bariatric surgery?

Bariatric surgery can broadly be defined as surgery on the stomach and intestines to help reduce obesity and obesity-related conditions. Obesity has been identified as a major health concern affecting men, women and children of all ages, not only in South Africa but globally. The high incidence of obesity has necessitated the establishment of programmes directed at the management of obesity and associated health complications.

Bariatric surgery for weight loss is a field which involves modern surgical techniques which present a realistic alternative to other weight loss options for obese patients. Research shows that gastric surgery can help patients lose approximately 50% of their excess body weight, compared to 5 to 10% of traditional weight-loss diet and exercise programmes. 

Bariatric surgery can help patients to lose approximately 50% of their excess body weight on average and sustain weight loss over a longer period.

Benefits of bariatric surgery

  • Weight loss from the surgical intervention generally ranges from 40% to 70% of excess body weight over the course of 12 to 18 months, depending on the person’s weight before surgery.
    • glucose intolerance;
    • diabetes mellitus;
    • sleep apnoea;
    • obesity-associated hypoventilation;
    • hypertension; and
    • serum lipid abnormalities.
  • There is also some evidence of improved heart function with decreased ventricular wall thickness and decreased chamber size. 
  • Bariatric surgery is associated with sustained weight loss over longer periods than is achieved by other methods. Specifically, research findings show that 60% of surgery patients continued to maintain a 50% level of weight loss over a 5 to 10 year period.
  • Patients who have had bariatric surgery report improvements in mobility and stamina as well as mood, self-esteem, interpersonal relationships and quality of life.
  • Though most commonly known as a treatment for obesity, bariatric surgery can improve several co-morbid conditions. These include:

Centres of excellence for metabolic medicine and surgery

There are currently five centres of excellence for metabolic medicine and surgery at Netcare hospitals, offering patients access to specialised bariatric surgery.

The only internationally accredited centre in South Africa for the treatment of bariatric and metabolic conditions is located at Netcare Waterfall City Hospital in Midrand, Gauteng.   It is the principal centre for the four other locally accredited bariatric centres of excellence located at Netcare hospitals. These are Netcare Sunward Park Hospital in Boksburg, Netcare St Augustine’s Hospital in Durban, Netcare Greenacres Hospital in Port Elizabeth and Netcare N1 City Hospital in Cape Town.

Endocrinologist, Professor Tess van der Merwe, who is the chairperson of the South African Society for Obesity Metabolism (SASSO), heads up the various centres. The dedicated multi-disciplinary teams at these centres are comprised of surgeons, psychiatrists, psychologists and dieticians, amongst others.

Bariatric surgery can improve a number of serious health conditions including diabetes, hypertension and sleep apnoea.

The centres adhere to international practices to create a safe environment and to support obese patients with empathy and care. To comply with international standards, a database with statistics on each patient is maintained. Strict rules and regulations with regard to patients’ dietary environment, as well as care in ICU and wards are followed. Training facilities with specialised technology and equipment are also incorporated in the centres.

Bariatric surgery procedures

Who qualifies for bariatric surgery

Various criteria are taken into consideration before a patient is accepted for bariatric surgery:

  • Patients between the ages of 18 and 65 years, with a body mass index (BMI) score of 40kg/m2 or more could qualify for surgery.
  • Patients with a BMI score of or 35 kg/m2 or more would qualify if they have at least two serious co-morbid conditions.
  • Patients should fully understand what the procedure will entail, the implications thereof, and be committed to a long-term lifestyle change and medical follow-ups.
  • Potential candidates for weight loss surgery must have made multiple attempts, in good faith, to achieve weight loss through conservative means such as dietary or pharmacological weight loss programmes. 

Types of procedures and their application

Two types of bariatric procedures are offered to obese patients:

  • The Roux-en-Y gastric bypass procedure (GBP)
  • Biliopancreatic diversion with duodenal switch (BPD) 

The Roux-en-Y gastric bypass procedure (GBP)
Biliopancreatic diversion with duodenal switch (BPD)

The GBP procedure is usually performed on patients with a BMI of 35 or more, and the BDP procedure on patients with a BMI of 50 or more.  The decision on which procedure is appropriate for individual patients is, however, also based on various physiologically-relevant factors.

Both of these surgical procedures are approved by two international regulatory bodies, namely the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), and World Obesity.

The BPD procedure may only be performed at the centres based at Netcare Waterfall City Hospital in Midrand and Netcare N1 City Hospital in Cape Town.

Patients are admitted on the morning of the surgery, and the surgery generally takes between one and two hours. Patients are not routinely admitted to the intensive care unit after surgery, and they are usually discharged from the hospital on the third or fourth day after surgery. The recuperation period ranges from four and six months. 

Patients have to follow a special post-operative diet and will require life-long medical follow-ups and vitamin replacements.

Preparation process for bariatric surgery

An extensive process is followed by the multi-disciplinary team to evaluate and treat candidates before bariatric surgery will be done.

The first step is the completion of documentation, whereafter the patient will usually meet with the psychologist for an evaluation. Where appropriate the psychologist will refer the patient to a psychiatrist for treatment. Family sessions are an essential part of this process.

The dietician then evaluates the patient’s dieting history, and initiates an eating plan taking into account cultural requirements and dietary preference of the patient. This is an essential step to foster some of the routines that the patient will have to adhere to after surgery, and is also essential for improving the patient’s physical health and nutritional education.

Next, the patient is seen by the specialist endocrinologist for a comprehensive evaluation and initiation of a treatment protocol before the patient’s eligibility for surgery is confirmed.

Prior to surgery, the patient consults with the surgeon, and various investigative tests are done as prescribed by the endocrinologist. These may include a gastroscopy, relevant blood tests, a lung function test and echocardiogram. If the patient has co-morbidities such as diabetes or hypertension, these also need to be understood and adequately treated before surgery can be approved.  All possible complications will be personally discussed with the patient by the specialists during face to face consultation.