Metabolic surgery in South Africa: an initial academic hospital experience

  • Jeanne Lubbe Stellenbosch University
  • Adiel Webner Stellenbosch University
  • André Potgieter Stellenbosch University
  • Wimpie Odendaal Stellenbosch University
  • Charl Cooper Stellenbosch University
  • Anton Lambrechts Stellenbosch University
Keywords: Obesity, Metabolic surgery, Laparoscopic Roux and Y gastric bypass

Abstract

Background: In South Africa, 42.0% of adult females and 13.5% of adult males are classified as obese, the highest recorded numbers in Sub-Saharan Africa. Metabolic surgery has been proven to be a safe and effective treatment, yet due to demand on government resources has only been performed to a limited extent in public hospitals. The aim of this study was to describe the safety and efficacy of performing metabolic surgery at a single academic hospital in South Africa.

Methods: This was a single centre retrospective review of 57 metabolic surgery procedures performed from October 2011 to September 2017 at Tygerberg Hospital, Cape Town, South Africa. The primary outcome was safety including mortality and adverse events. Secondary outcomes included effect of surgery on weight and diabetes resolution.

Results: A total of 57 patients underwent laparoscopic metabolic surgery, of which 44 (83.0%) were female with a mean age (standard deviation) of 42.8 (8.0) years. Fifty-six patients (98%) underwent Roux-and-Y gastric bypass and one (2%) had a sleeve gastrectomy performed. There were no mortalities and overall morbidity was 14.0%, with 3 (5.3%) classified as major and 5 (8.8%) as minor. The follow-up rate at 1 year was 100%. Mean preoperative body mass index (BMI) was 58.8 kg/m2, and comorbidities included hypertension (59.6%), Type 2 Diabetes (42.1%), and dyslipidaemia (36.8%). There were no conversions to open surgery and at one year the mean (95% confidence interval) percentage excess body mass index loss was 50.4% (44.0–56.8%).

Conclusions: Metabolic surgery can be performed safely in the public sector in South Africa, with short-term safety and efficacy outcomes comparable to international reports. Larger scale studies are needed to determine long-term outcomes and cost-effectiveness.

Author Biographies

Jeanne Lubbe, Stellenbosch University

Division of Surgery, Tygerberg Hospital and the University of Stellenbosch

Adiel Webner, Stellenbosch University

Division of Surgery, Tygerberg Hospital and the University of Stellenbosch

André Potgieter, Stellenbosch University

Division of Surgery, Tygerberg Hospital and the University of Stellenbosch

Wimpie Odendaal, Stellenbosch University

Division of Surgery, Tygerberg Hospital and the University of Stellenbosch

Charl Cooper, Stellenbosch University

Division of Surgery, Tygerberg Hospital and the University of Stellenbosch

Anton Lambrechts, Stellenbosch University

Division of Surgery, Tygerberg Hospital and the University of Stellenbosch

Published
2019-05-14
How to Cite
Lubbe, J., Webner, A., Potgieter, A., Odendaal, W., Cooper, C., & Lambrechts, A. (2019). Metabolic surgery in South Africa: an initial academic hospital experience. South African Journal of Surgery, 57(2), 20-26. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2804
Section
General Surgery