The Process

What is Obesity?

What is Obesity?

Why do diets fail?

Why do diets fail?

metabolic setpoint

The metabolic set point

What is Bariatric Surgery?

What is Bariatric Surgery?

How do I get started?

How do I get started?

more about us

More about our team

the process

A journey of a thousand miles begin with a single step, in this case- with a single call or email. Contact us to set up your appointment or find out if you will qualify for bariatric surgery.

 

STEP 1

Contact the bariatric coordinator Dailina Barnard at:

She will go through a quick checklist to see if you are eligible for bariatric surgery.

 

Some of the information she will need is:

  • The type of medical aid and plan you are on
  • Your BMI or last known weight and height
  • For private patients (or have a medical aid that does not authorise bariatric surgery) whether or not you will be able to afford bariatric surgery or be able to obtain financing.

She will then proceed to book an initial visit to the unit for you as well as forward an information pack. She will also be able to furnish you with the necessary list of blood tests that must be done before your first consultation.

 

STEP 2: THE FIRST ASSESSMENT

The first visit to the unit will be an appointment with the clinical psychologist and dietician. The first appointment with the psychologist will be approximately 2 hours and will include an info session on bariatric surgery, a clinical interview and some baseline testing so that we can better understand your relationship with food and the impact of obesity on your life.

 

The second appointment is with the dietician, this appointment will be for 1 hour during which a full diet history and evaluation will be conducted. Basic measurements will be taken and an anthropometric profile will be created.

 

This information will be vital in assessing your risk and also in showing us how we can build a plan of support for you through your bariatric journey. A provisional date for surgery will then be given to you so that a time scale can be established and you can plan for your future.

 

STEP 3:

The visit to the physician will be next on the list, he will assess your risk for surgery and start to optimise any chronic diseases that might impact on your fitness for bariatric surgery.

This can include additional testing such as:

  • Dexa scan of lumbar spine and hip in estrogen-deficient patients (post-menopausal females) and individuals who are at risk for metabolic bone disease
  • Sleep apnea evaluation if sleep apnea is known or suspected
  • Cardiology testing
  • Electrocardiography
  • Echocardiography
  • Pulmonary testing
  • Chest radiography

 

STEP 4:

The visit to the bariatric surgeon will then be next on the list. He will assess your surgical risk and help you choose the procedure best suited to you and explain some of multitude of questions that will no doubt have arisen by this time. A baseline gastroscopy will be done and any previous surgery that has been done and the impact thereof will be discussed.

Step 2-4 is usually done over a 2 day period and should you travel from far away overnight might be advisable, our friendly staff can help you secure suitable accommodation if needed.

 

STEP 5: THE INTERIM VISIT.

At this visit you will again see the psychologist, dietician, physician and surgeon. All test results will then be reviewed and fitness for bariatric surgery will be determined. This is usually done about 4 weeks after the initial visit with extra consultations/testing having been identified during the first visit. The team will then discuss your case and determine whether any unresolved issues have been identified that have to be addressed prior to going for surgery.

 

STEP 6: THE PREOPERATIVE VISIT

This visit is 2 weeks prior to your surgery

The dietician will now start you on the preoperative diet, this is a special liquid diet that will prepare you not only for surgery but will also help you adapt to the diet you will be following directly after surgery. The physician will supply you with the necessary operation pack/script including vitamin supplements, anticoagulation and suitable pain medication. Final arrangements will be made and authorisation will be obtained from your medical aid. After all co-payments/payments to the hospital and medical teams have been finalised the day of your surgery has arrived.

 

STEP 7: THE SURGERY

Admission to the hospital will usually be at six in the morning on the day of surgery, the anaesthetist will then supply premedication to calm you before surgery and the nursing staff will make final preparations for surgery. Surgery lasts between 1 and 3 hours and post-operative care will be done in a specially designed private room ideal for bariatric patient needs. In cases where special issues have been identified pre operatively high care or ICU may be used.

The usual length of stay aimed for in the hospital is 2 nights, this is the amount of time needed for perioperative intravenous pain relief, the physiotherapist to get the lungs and legs going and gain mobility. The dietician will initiate the post-operative fluid diet and intravenous antibiotics will be given to cover against post-operative pneumonia.

 

STEP 8: THE FIRST FOLLOW UP

Two weeks after the operation you will again follow-up with the surgeon, dietician and as needed with the physician and psychologist. All wounds will be inspected, dressing changed, drains removed and the dietician will start you on stage 2 diet (a pureed diet) as your stomach becomes used to handling increased density foods.

 

STEP 9: LONG TERM FOLLOW-UP

  • 30-day follow-up
  • Every 3 months for the 1st year
  • 18-month follow-up
  • 24-month follow-up
  • Annually thereafter

All members of the team will be consulting with you at these follow up appointments as the need arises.

YOUR CHECKLIST OF PRE-OPERATIVE TESTS INCLUDES:

  • Vitamins A, D, E and K, B1, B12-folic acid assessment, so deficiencies can be treated before surgery if needed (E, K, B1 and B12 recommended)
  • Iron and zinc levels (pre-operative correction if appropriate)
  • Thyroid stimulating hormone
  • Gastrointestinal evaluation including abdominal ultrasound, gallbladder evaluation and upper endoscopy with biopsy for H. pylori
  • Drug screen
  • Nicotine screen
  • Smoking cessation for 8 weeks if indicated
  • Clearance from your physician and/or psychiatrist For Gastric Bypass:
  • 1 week post-operative check-up
  • 30-day follow-up
  • Every 3 months for the 1st year
  • 18-month follow-up
  • 24-month follow-up
  • Annually thereafter