Gastric bypass surgery is popularly associated with weight loss, however it is the health and wellness benefits, rather than the cosmetic changes, that can be achieved with holistic, multidisciplinary support that are the greatest benefits to be gained with this type of intervention.
Photo: "Since their gastric bypass operations, Marthinus and Cecilia Deetlefs have lost 33kg and 49kg respectively, and say they feel more energised since the procedures."
“Before my gastric bypass surgery in August last year, I weighed close on 117kg while my husband was at 143kg before his surgery at the end of March this year, and we both suffered from hypertension. I never would have believed that within a year we could feel so energetic and healthy as we do now. In fact, we no longer have to take blood pressure medicine, as our hypertension has been resolved since the surgery,” says 53-year-old Cecilia Deetlefs of Warner Beach, KwaZulu-Natal.
“Aside from the hypertension, my husband was suffering from obstructive sleep apnoea and he also started experiencing problems with one of his knees, leading an orthopaedic surgeon to advise that he would soon have to have a knee replacement.”
Obstructive sleep apnoea is a condition whereby the muscles of an individual’s airway relax to such an extent during deep sleep that the airway becomes blocked. The condition is commonly associated with obesity and can cause the sufferer to feel fatigued and have difficulty concentrating during the day.
Thirty-three years ago, Cecilia and her husband Marthinus, now 58, both underwent vertical banded gastroplasty procedures whereby the size of the stomach is restricted with staples and synthetic mesh to reduce the volume it can accommodate. “We have both battled with our weight for much of our lives, and initially we did lose weight following the operations all those years ago,” she recalls.
Over time, however, the synthetic mesh used in 1980s operation had caused excessive scarring to Cecilia’s stomach and this led to complications. “I never felt really well after that operation, and neither of us could eat fish, chicken or meat. We learned to live with that, but as the years went by we started gaining weight again and this negatively affected other aspects of our health too.”
Last year, Cecilia began to feel extremely sick and was unable to eat anything. Her general practitioner referred her to specialist surgeon, Dr Gert du Toit, who found that scarring and fibrosis resulting from the synthetic mesh used in her operation over 30 years ago had caused stricture of her stomach. He recommended a gastric bypass operation, during which he would be able to address the stricture.
“At first, I thought it was a strange suggestion to have a gastric bypass when I am unable to eat, and Dr Du Toit and I actually had a bit of a disagreement about it initially,” she recalls. “Then he explained how the procedure works, and how it could help to rectify some of the issues resulting from my surgery all those years ago, as well as obesity-related health conditions, including the hypertension from which I suffered, and I decided to go ahead with the operation.
“A few months after the procedure, I was feeling so much better. My husband made an appointment with Dr Du Toit to investigate whether a gastric bypass could be a suitable option to help him address the health problems he was facing.”
Dr Du Toit, who was recently recognised with the inaugural metabolic medicine and surgery ‘Centre of the Year’ award from the South African Society for Surgery, Obesity and metabolism (SASSO) for his work in laparoscopic gastric bypass procedures at Netcare St Augustine’s Hospital in Durban, says that Cecilia’s operation was a particularly complex one.
“There was a lot of scar tissue in Mrs Deetlefs’ stomach that had to be removed with painstaking care as part of this gastric bypass. It was one of the more complicated cases I have seen in my 20-year career,” he explains. Dr Du Toit specialises in complex digestive laparoscopic procedures, which involve minimally invasive or ‘keyhole’ surgery associated with lower risk of complications than open surgery, particularly for obese patients, and shorter recovery times.
Dr Du Toit says that the surgery itself is only one aspect of the holistic treatment patients receive. “Sometimes surgery is not the solution best suited for the particular patient, and it is extremely important that a multidisciplinary team of healthcare professionals assess the patient and that on-going support is provided to secure the best possible outcome for them.”
The multidisciplinary team Dr Du Toit and his partner, gastroenterologist and surgeon Dr Ivor Funnell, work with includes an endocrinologist, physician, dietitian, psychiatrist or psychologist and biokineticist. This holistic approach helps to determine the most practical solution for each patient’s individual needs.
Dietitian Mandy Read provides patients with a nutritional plan to help them lose weight and change the consistency of the liver in preparation for the surgery. Mr Deetlefs lost 23kg on this diet ahead of his surgery, while Mrs Deetlefs lost 8kg ahead of her operation, as her procedure had to be done urgently to address the complications from her previous surgery.
“To help ensure lasting, quality outcomes, we remain in contact with patients and they are encouraged to attend monthly support group meetings. It is quite amazing to see the change in many of our patients – and it goes far beyond what can be achieved with surgery alone,” Dr Du Toit observes.
Since their gastric bypass operations, Marthinus and Cecilia Deetlefs have lost 33kg and 49kg respectively. In total, including the weight loss achieved from their pre-surgery diets, Cecilia has lost 57kg and Marthinus has lost 56Kg. She has achieved her goal weight of 68kg, while he aims to lose a further 15kg.
Cecilia says that she and her husband both have more vitality than they have had in years. “I never dreamed that I could feel like this, I have so much energy now and I feel like I’m 16 years old again. We work for a waste and garden refuse removal service, and we are both finding great enjoyment in getting physically involved. We have also found that we do not crave sweet or fatty foods any longer. I never used to enjoy salad, but now I just love healthy, fresh food – and, at last, I have been able to eat protein again.
“Since having his gastric bypass, my husband’s weight loss has cured his sleep apnoea and he has no need for the breathing device he previously had to sleep with every night – he hardly even snores anymore, and no longer feels exhausted during the day. In addition, he has been told that he will not require a knee replacement any longer because there is now far less strain on his knees,” she relates.
“Mrs Deetlefs is a great example of how people can really blossom after making positive changes in their lives and redefining themselves to be exactly who they want to be,” Dr Du Toit observes. “Watching her progress has been so rewarding. It’s like watching a flower open, and there is so much more to her transformation than just the weight loss aspect. She has so much more confidence, and this shines through strongly now,” he concluded.
Notes to editors:
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, including gastric bypass procedures.
These centres of excellence are located at Netcare Sunward Park Hospital in Boksburg, Netcare St Augustine’s Hospital in Durban, Netcare Greenacres Hospital in Port Elizabeth, Netcare N1 City Hospital in Cape Town, and Netcare Waterfall City Hospital in Midrand, Gauteng. The centre at Netcare Waterfall City Hospital is the only internationally accredited centre for the treatment of bariatric and metabolic conditions in South Africa, and is the principal centre for the four other locally accredited centres of excellence located at Netcare hospitals.
The dedicated multi-disciplinary teams at these centres are comprised of surgeons, endocrinologists, psychiatrists, psychologists and dieticians, among others, in line with the protocols advocated by the South African Society for Surgery, Obesity and metabolism (SASSO), which is chaired by endocrinologist, Professor Tess van der Merwe. As director of the Centres of Excellence for Metabolic Medicine and Surgery of South Africa (CEMMS)(SA), Prof Van der Merwe oversees the work of the centres of excellence, including those based at Netcare hospitals.
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.
Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare St Augustine’s Hospital
Contact: Martina Nicholson, Graeme Swinney, Meggan Saville and Pieter Rossouw
Telephone: (011) 469 3016
Email: [email protected], [email protected], [email protected] or [email protected]