What/who is the first port of call?
If you are considering bariatric surgery and think you fulfil the criteria required, or if you are unsure, then contact our Bariatric Coordinator, Cathy, for the first appointment. She will discuss team participation, the work up to surgery, the surgery itself, life after surgery and costs. There is no charge for the appointment and no obligation to continue, but the appointment will help you to make further decisions based on the facts.
What are the criteria?
According to local and international criteria, patients may be considered for surgery if they have a BMI of 40 and higher, or a BMI 35 to 39 with specific diagnosed comorbidities e.g. diabetes, hypertension, sleep apnoea, raised cholesterol etc. Certain symptoms such as depression, PCOS, knee pain etc are not regarded as comorbidities but rather side effects.
Do medical aids fund the surgery?
Various (but not all) medical aids fund bariatric surgery. Certain medical aids require patients to be on specific plans. Medical aids follow strict criteria for authorising surgery. Gap Covers generally do not cover the extra costs, as most have obesity as an exclusion.
How long will it take before I can have surgery?
We want to make sure that all our patients are fully prepared, both physically and emotionally, before they have surgery, in order to ensure optimal success. We therefore do not like to rush the process. You can usually expect a 2-3 month wait between starting to see all team members and having your surgery done. This may be longer if you require more time to make the behavioural and lifestyle changes required, or if you have underlying medical conditions (such as diabetes) that require management.
Is there pre and post-operative support?
Yes! You will be guided through the pre-surgery process by our team of experts, who will ensure that you are ready both physically and mentally for the surgery.
Post surgery support is vital for ongoing success, and an important part of our team approach. We have an official patient support group for pre and post op patients that meet once a month, as well as patients who manage their own whatsapp group.
Why the team approach?
Each member of our team has a vital part to play in getting you ready for surgery, making sure the surgery goes smoothly, and ensuring your continued success in the future. You will need to see each member of the team who will assess your suitability for surgery, and look after a particular area of your well-being, both before and after surgery. Our team formally meet once a month to discuss our patients, and are focused entirely on optimising you prior to surgery so that you gain maximum benefit from your operation. Besides our formal meeting, the team communicate constantly with each other to ensure that you have the best, and most thorough, medical care available to you.
What is the role of each team member?
Our bariatric coordinator
You will meet Cathy at your first appointment, where she will explain the process and guide you through enrolment with our clinic. Once you have decided to join the programme, Cathy will ensure your work up runs smoothly with the various requirements, and help you with medical aid authorisation. She also manages the patient support group.
Our endocrinologists
Our endocrinologists are both founding members of the Cape Town Bariatric Clinic (previously Chrysalis Clinic). Their role in the clinic is to assess patients suitability for bariatric surgery and exclude possible endocrine or metabolic causes, as well as determine associated obesity related complications that would need to be attended to prior to surgery. If necessary, they will also discuss other weight-loss medical options prior to surgery. Post surgery they are responsible for the long-term follow up of patients, with special consideration given to known complications.
Our dieticians
Ensure you understand the dietary changes that will be required before and after surgery. A healthy, balanced diet is vital after surgery. You will also require vitamin supplementation, which will be carefully monitored after surgery to ensure your new way of eating is providing you with all the nutrients you need. Your diet will undergo quite a radical change after surgery, and ongoing dietetic support will assist you in making the required changes.
Our biokineticist
Exercise will not only get you fitter for surgery, thereby reducing risk of complications, but it is an essential part of the long term lifestyle changes you will need to make to achieve maximum weight loss. Exercise can be challenging when you are overweight, and Mandy can get you moving in a safe and non-threatening way. Mandy will ensure you are fit enough before you make an appointment to see our physician, Dr Turner.
Our psychiatric team
Psychological assessment before surgery is imperative to identify and correct factors that could be contraindications to surgery. Even more importantly, it will assess the motivation and readiness, behavioural challenges and emotional factors that might influence your ability to cope with life during the work up and after surgery. Remember that surgery is a life-changing event, and you will need help adjusting to this.
Our surgeon
Ian Marr is an accredited bariatric, laparoscopic and general surgeon who will assess the type of surgery that is most suitable for you according to his examination, your history and the reports from our team. He will also perform a gastroscopy on you. He has an experienced anaesthetist, Dr Spencer Burke, and dedicated team of specialist nurses, all trained to ensure your surgery goes smoothly.
Our physician
Will assess your heart and lungs together with a blood count, biochemistry, ECG and chest x-ray prior to surgery, ensuring that you are as low a risk as possible for anaesthetic. He will also look after you in the immediate post-surgery period, and will keep a close eye on your blood pressure, blood glucose (if required), heart rate and temperature, together with your fluid balance status whilst you are in hospital.
Our GIT ward and staff
The GIT (gastrointestinal) ward has private rooms specifically set up for our patients according to bariatric accreditation requirements. The friendly nursing staff are experienced in managing our patients post surgery.
Our anaesthetist
Has much experience with managing our bariatric patients in theatre and makes sure of a safe anaesthetic for you by also taking any comorbidities, allergies and medical history into account. After transferring you to our theatre recovery area when your surgery is completed, he will ensure your vital signs are sufficiently stable before you return to the ward.
Our physiotherapists
The ward staff notify the physiotherapists as soon as you return to the ward post-surgery. They will assist you getting out of bed and take you for your first walk after surgery. You will be shown breathing exercises to ensure optimal lung function. The physiotherapists see you regularly to prevent post-operative complications such as pneumonia and deep vein thrombosis.
Our plastic surgeon
With a large amount of weight loss post operatively, patients are likely to have excess skin. For some, it may not be a concern, however there are those that may be affected by this e.g. whether it be for cosmetic reasons or excess skin that causes irritation when doing exercise. The surgery is usually performed 6 months to a year after the bariatric procedure, once the weight loss has stabilised, and often involves multiple body areas. The excess skin and tissue is removed and tailored to improve the body contour. The surgery is truly a combination of art and science and very rewarding for both surgeon and patient. Unfortunately, medical aids do not fund this surgery.