In the case of significant obesity, bariatric surgery may be worth considering. To qualify, you must meet the following criteria:

• Have a body mass index (BMI) higher than 40 or a BMI of 35 with associated complications such as type 2 diabetes. Lower BMI may be considered in special circumstances.
• Be age 18 to 65. Outside this range will be assessed individually.
• Have no psychological issues that would make bariatric surgery inadvisable.
• Reasonable surgical candidate. Full pre-operative individual surgical risk assessment before final decision is made
• Suitable for general anaesthetic, again individual risk assessment necessary before final decision is made.

Bariatric surgery will only be considered if you have attempted, unsuccessfully, to lose weight using specialised medical treatment for several months (with dietary monitoring, physical activity, and psychological therapy). The decision to operate is made jointly by you and your attending physician, surgeon, endocrinologist, nutritionist, and psychologist or psychiatrist.

Weight loss goals

The goal of obesity treatment is to reach and maintain a healthy weight. You will need to work with a team of health care professionals — including a dietitian, behaviour counsellor or an obesity specialist — to help you understand and make changes to your eating and activity habits.

Bariatric surgery does not guarantee a certain amount of weight loss.

The surgery is a catalyst for weight loss – ultimately it is up to you to reach your weight-loss goals. Success depends on personal motivation and effective behavioural change.

Risks and complications

As with any major surgery, weight-loss surgery has risks. Complications are rare yet can become significant due to obesity. Conditions such as diabetes, hypertension and sleep apnoea tend to increase the risk of complications. Thorough pre-surgical preparation along with careful follow-up can reduce the risks. However, it is important that you fully understand all potential risks in order to make an informed decision.

Your skilled surgical team will, of course, do everything they can to avoid complications. If a problem does occur, your surgical team will seek to resolve it as quickly as possible.

The sleeve gastrectomy, also known as the gastric sleeve, reduces the size of the stomach by around 80%. This means you feel full more quickly (increased satiety) and you experience a decrease in appetite. The procedure is usually performed laparoscopically and takes between 60 and 75 minutes to complete. This procedure has shorter operating times, lower complication rate and faster recovery times compared to other bariatric procedures.

OMEGA LOOP GASTRIC BYPASS (Mini-gastric bypass)

The procedure

The omega loop gastric bypass, or mini-gastric bypass, is an alternative to the Roux-en-Y procedure and consists of two steps: reduction of the stomach and looping of the small intestine to connect to the smaller stomach.

1. The stomach is divided along its entire length, creating a long narrow tube.
2. A loop of the small intestine is then brought up and attached to the newly created stomach tube. This process bypasses the upper part of the intestine while still enabling drainage of digestive juices from the detached part of the stomach.

GASTRIC BANDING (LAPAROSCOPIC ADJUSTABLE BAND OR LAP-BAND)

Gastric banding is a restrictive surgical procedure that uses a band to reduce the size of your stomach without cutting or stapling. The aim is to slow and limit the amount of food that can be consumed at one time, helping you feel full faster and stay satisfied for longer periods of time, thus promoting gradual weight loss.

The procedure

An inflatable band is placed around the upper part of the stomach to make the stomach pouch smaller. It is adjustable (adjustments can be uncomfortable) and can be adapted to suit the individual patient. You will have a port attached to the band that is placed flat against the muscle wall, below the fat and skin of your abdomen. The band is adjusted or tightened by either adding or removing fluid through the port. It will need to be adjusted periodically to control hunger and enable weight loss to progress in the months following your surgery. Your first adjustment will be around 4–6 weeks following surgery, giving your body time to heal. It is common to experience swelling around the band.

The Roux-en-Y gastric bypass is one of the most common weight loss surgical procedures. It results in weight loss by significantly reducing the size of your stomach, so you cannot eat as much, and by bypassing your small intestines, so you absorb less fat from the foods you eat.

The procedure

This procedure comprises two steps: partitioning of the stomach and reconstruction of the gastrointestinal tract.

• • A small pouch is created from the upper stomach using staples. This process leaves the larger part of the stomach non-functional.
  • The small intestine is divided into two parts. One end is then attached to the stomach pouch. The other end, which is still connected to the part of the stomach that is no longer functional, is reattached to the intestinal tract to enable drainage of the digestive juices.

In the days immediately following bariatric surgery, you may feel pain where the incision was made or from the position your body was in during surgery. Some patients may also experience neck and shoulder pain after having a laparoscopy.  

Your comfort is very important to your health care team.

Although there will always be some discomfort after an operation, keeping your pain under control is necessary for your recovery. When you are comfortable, you are better able to take part in activities such as walking, deep breathing, and coughing, all of which are imperative for a quick recovery.

If you have experienced significant weight loss after bariatric surgery, you may be left with excess skin in certain areas of your body. Some bariatric surgery patients opt for reconstructive surgery to remove this loose skin.

Plastic surgeons use contouring techniques such as tummy tuck and body lift to remove post-bariatric excess skin. These procedures have proven successful in refining the patient’s body and helping them enjoy everyday activities to the fullest.

To qualify for post-bariatric reconstructive surgery, patients must meet certain health requirements. Ask your GP or surgeon if you are a good candidate. If you are not, try to find out what you can do to improve your health status in order to qualify.

Criteria for reconstructive surgery:

• Good general health status
• At least 1.5-2 years after bariatric surgery

Weight loss has been concluded for at least 6 months

• BMI of 25 or lower – to ensure better short-, mid- and long-term results
• No vitamin/mineral deficiency
• No smoking – promotes better healing of scar tissue
• No active pregnancy, no pregnancy planned for the next 2-3 years
• Stable diet and regular exercise
• Realistic expectations

Many people want to know if their health insurance or public health system will cover the cost of post-bariatric reconstructive surgery. Some procedures are covered, while others are not.

With the exception of certain types of breast reduction surgery, post-bariatric reconstructive surgery is usually performed by private clinics. The patient should check the health insurance provider to find out their level of cover. The best approach is to cross-check cover with item numbers. Some private clinics only offer limited no-excess reconstructive surgery. We provide limited abdominal reconstruction procedures.