Providing the necessary care to bariatric surgery patients requires the involvement of numerous medical specialists working in an organised team. This care begins during the assessment phase of new patients and continues long after the actual surgery.
Bariatric surgery requires the care of a team of specialists during the assessment phase, the surgery and long after as they recover and form new life habits.
In the first phase, a prospective patient needs to be seen by all the principal members of the bariatric team so that an assessment can be made.
These are Dr Andrew van der Walt (Endocrinologist), Dr Henry van Niekerk (Bariatric Surgeon), Helen Jones (Psychologist), and Fran Steart from Steart & Barnard dietitians.
During these assessments, comprehensive evaluations are made and some blood tests are done. An ECG, sleep study, chest X-ray and liver ultrasound are done. A clear funding plan is established.
The patient is then discussed by the multidisciplinary team in a meeting where all potential issues are considered. Sometimes problems like excessive alcohol use or chronic medication that needs altering first need to be addressed before the green light is given to go ahead with the surgery.
The second phase begins when the patient has approval from the team.
A date for the surgery is scheduled. This is usually 3 months later to allow time for the dietary preparation and any additional tests. These include gastroscopy and sometimes further blood tests, a bone scan, lung function tests, cardiac ultrasound and coronary angiography.
An appointment will need to be made with the anaesthetist 2-3 weeks before surgery.
Once all this information is available, a medical aid motivation is submitted for those patients whose medical aids part-cover the procedure.
The third phase is the hospitalisation period of 2 to 3 days when surgery takes place. The operation will take about 2 hours and the patient will spend the night in the high care unit. When the patient awakes, water is taken orally. The next morning an X-ray study will be done to confirm gut function, and clear fluids will be started orally.
The patient will move to the general ward and is encouraged to get up and move around. When ready, the patient will return home. Home care will likely be required by family or friends for a week. Only liquids are taken initially and slowly increased over 6 weeks to normal eating. The patient can return to work 2 weeks after surgery.
The final phase is the remainder of the bariatric patient’s life. Weight loss after surgery is expected to be between 5-7 kg per month for 6 months. Thereafter it slows to 2-3 kg per month for the subsequent 6-12 months, and often reaches a plateau at this stage. Weight loss usually remains durable lifelong after surgery, although mild weight gain after 2-5 years is common.
After 6 weeks patients can eat normally, which takes the form of normal, healthy small meals 6 times a day. (Remember the stomach volume is greatly reduced – see ‘bariatric surgery explained’ page.) Patients can enjoy going to a restaurant or visiting friends for dinner – no special diet is required on these occasions. Healthy eating remains important lifelong for successful weight loss, and long-term follow up with a dietitian is mandatory. Daily vitamin and micronutrient supplementation are necessary due to the malabsorptive component of the procedure, and this needs to be factored into the long-term costs after the operation. A yearly follow-up with a doctor is scheduled to assess nutritional health and surgery-specific conditions.
The improvement in quality of life due to durable, long-term extreme weight loss is the reason patients embark on this journey. As explained, it is not an easy or simple undertaking and requires huge emotional, physical and financial investment. For most very obese people, surgery remains the only intervention capable of effecting real change, and this intervention provides an honest chance at a new, better life.
All of us at the Hilton Bariatric Unit are here to help you along this journey.
