Bariatric and Metabolic Unit

What is obesity?

Obesity is a disease. It is not a lifestyle problem that can be resolved by merely exercising more and eating less. Although these lifestyle changes may be effective in a small percentage of patients (5%), the majority of patients struggle to lose weight ór keep from gaining back any weight lost by making lifestyle changes.

Obesity is also the root cause of a number of other negative medical conditions such as hypertension, sleep apnoea, high cholesterol, cardiovascular disease and type 2 diabetes. These conditions can significantly shorten one’s life if it remains untreated.


Bariatric surgery is the collective term used to describe a number of surgical procedures that induce weight loss by making changes to the digestive system. Over the past thirty years, bariatric surgery has been proven the most effective tool to treat obesity and its associated medical conditions. 85-95% of patients will lose weight and will maintain weight loss following bariatric surgery. Furthermore, 90% of patients will have resolution of diabetes and 80% will have resolution of hypertension and other co-morbidities. Because bariatric surgery decreases complications of obesity, improves quality of life and increases life expectancy by 10-12 years, more and more medical aids are funding these procedures for their members.

The following patients are considered candidates for bariatric surgery:

  • Patients with a Body Mass Index (BMI) of over 40
  • Patients with a BMI over 35 with other co-morbid diseases associated with obesity (as mentioned above)
  • Patients with a BMI over 30 with poorly controlled type 2 diabetes


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Restrictive procedures

Lap Band: This procedure was very popular in the 1990’s, but long-term results have proven poor and it is fast becoming obsolete. This procedure is not being done at our unit.

Gastric balloon: This is only a temporary intervention that has proven expensive with poor long-term results. It is not being done at our unit.

Endoscopic gastric plication: This is a new procedure that is not currently done in our unit, because there is not enough data available on the long-term results of this procedure.

Gastric sleeve: This is a technically easier procedure and therefore the most popular procedure done worldwide. We do this procedure for very specific indications at our unit.


Laparoscopic Roux Y gastric bypass (LRYGBP): This procedure works by restricting the size of your meal and by interrupting the message pathways between the gut and the part of the brain that controls your satiety. This procedure is done at our unit.


Scopinaro: This is the name of the original procedure that was done by Professor Scopinaro. Is has gradually evolved into the billio pancreatic diversion and duodenal switch (BPD-DS), commonly referred to as the BPD.

BPD: This is currently the procedure of choice for patients with a BMI above 50, or with severe metabolic disease. It is a technically difficult procedure that has very good long term results. This procedure is done at our unit.

SADI: First described in 2007, the single anastomosis duodenal ileostomy (SADI) is a newer modification of the BPD-DS. Medium term results on this procedure is very promising. Although it is a relatively new procedure, these positive results have led to endorsements by both the American Society for Metabolic and Bariatric Surgery (ASMBS) as well as the International Federation for the Surgery of Obesity (IFSO). This procedure is done at our unit.


When bariatric surgery is performed by an experienced surgeon on patients who have been properly prepared by a multi-disciplinary team, the operation is safe and successful. Dying as a result of having gastric bypass surgery is extremely rare. The procedure has a 99.8% survival rate. In fact, the chances of dying from an obesity related health condition is much greater.


Because obesity is a complicated metabolic disease, it has to be treated by a multi-disciplinary team that includes physicians, dieticians and psychologists. To ensure the best possible outcome, look for an accredited and experienced surgeon who works as part of such a multi-disciplinary team and who can offer a variety of surgical procedures to suit individual patient needs.


Each patient will have a custom treatment plan which will have different cost implications. A number of medical aids in South Africa cover portions of the treatment. To find out more, please get in touch with the Bariatric Coordinator at Zuid-Afrikaans hospital: or attend one of the monthly online information sessions.