A Pretoria surgeon who this month carried out the continent’s first experimental lymphovenous bypass on an Alzheimer’s patient said there had been early signs of improvement, but that the procedure was still investigational, reports News24.
Dr Ben Moodie, a reconstructive and plastic surgeon at Cintocare Hospital in Pretoria, said the procedure was performed on 7 April on a 70-year-old man with advanced Alzheimer’s.
The operation is part of an emerging field exploring whether improving neck lymphatic drainage affects brain health, and was performed by Moodie alongside assistant Dr Heinrich Janse van Rensburg, anaesthesiologist Dr Adolf Fourie, and supported by a multidisciplinary theatre and radiology team, including Dr André Bam and theatre staff led by Jolene Cilliers.
Gauteng-based Moodie studied at the University of Pretoria, specialising in plastic surgery before completing fellowships in Japan, South Korea and Spain in reconstructive microsurgery and lymphatic supermicrosurgery.
“Those skills are not widely available locally, which is why I trained overseas,” he said, adding that his primary work is not cosmetic, but reconstructive surgery for cancer patients.
“My day-to-day work is focused on head and neck cancers. We do major resections where parts of the jaw, eye or cheek may be removed, and then we reconstruct those areas using tissue from elsewhere in the body.”
The procedure draws on the idea that Alzheimer’s may relate not only to brain changes but also to impaired waste clearance.
“The idea that lymphatic surgery could play a role in brain diseases has been discussed over the past three to four years within lymphatic surgery circles. It is not a completely new concept,” Moodie said.
“The initial procedure was performed in China as an incidental finding. From there, the technique was further developed and refined in places like Seoul, South Korea, which is the approach we replicated.”
Before the operation, the hospital conducted extensive ethical and clinical reviews involving multiple specialities.
“We had an internal hospital ethics process involving ENT surgeons, neurosurgeons, plastic surgeons and maxillofacial surgeons, as well as the hospital board, to review safety and feasibility.”
The approach has attracted mixed reactions within the medical community.
“With any new development, there are always different responses. Some colleagues are excited, some are sceptical, and some are not interested,” he said. “Neurology was particularly cautious because this goes against conventional treatment approaches.”
The patient was chosen after multiple screenings and was medically fit despite advanced symptoms.
“We screened multiple patients and selected one with significant Alzheimer’s symptoms who was still medically fit enough to undergo several hours of surgery.”
He added that the case was also personally significant.
“The patient was a distant relative. I have known him for about 20 years, so I had observed his decline over time.”
The four-and-a-half-hour procedure was completed without complications, and the patient spent one night in the hospital. Moodie said post-operative improvements appeared almost immediately.
“Before surgery, he was disoriented and had very poor memory. The morning after surgery, he was able to respond in full sentences and engage appropriately. Within days, his family noticed he was more alert, walking faster, and more present.
“In one instance, he recognised family he had previously been unable to identify.”
Despite these early signals, Moodie cautioned against drawing conclusions.
“We are still at a very early stage. Formal assessments will be done at three and six months, along with repeat brain scans, to measure any changes objectively.”
A lack of effective Alzheimer’s treatments had motivated this exploration.
“Alzheimer’s is one of the leading causes of death globally, yet we still don’t have effective answers. Even a small improvement … would already be meaningful.”
He also explained the theoretical basis behind the procedure, saying Alzheimer’s may involve impaired brain waste clearance.
“The brain has a specialised waste clearance system. When it slows down or becomes inefficient, waste may accumulate. In Alzheimer’s, this drainage system may be partially blocked or overwhelmed.”
The lymphovenous bypass aims to improve fluid drainage from the brain via the lymphatic system in the neck, and creates new pathways for fluid outflow.
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New findings may mean hundreds of thousands misdiagnosed with Alzheimer’s