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Berkane Y, Saget F, Lupon E, Mocquard C, Pluvy I, Watier E, Lellouch AG, Duisit J, Chaput B, Bertheuil N. Abdominoplasty and Lower Body Lift Surgery Improves the Quality of Life after Massive Weight Loss: A Prospective Multicenter Study. Plast Reconstr Surg 2024; 153:1101e-1110e. [PMID: 37189244 DOI: 10.1097/prs.0000000000010683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study was conducted to assess the impact of abdominoplasty and lower body lift surgery following massive weight loss on both the general quality of life and the sexual life of patients. METHODS The authors performed a multicenter prospective study on the quality of life after massive weight loss using three scoring questionnaires: The Short-Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of Life Questionnaire. Seventy-two patients who underwent lower body lift and 57 patients who underwent abdominoplasty in three centers with preoperative and postoperative evaluation were included. RESULTS The mean age of the patients was 43.2 ± 13.2 years. All categories of the Medical Outcomes Study Short-Form 36 Health Status Survey questionnaire were statistically significant at 6 months, and all categories except health change were significantly improved at 12 months postoperatively. Overall, the Moorehead-Ardelt questionnaire showed a higher quality of life in general (1.78 ± 0.92 and 1.64 ± 1.03 at 6 and 12 months, respectively) and in all domains (ie, self-esteem, physical activity, social relationships, work performance, and sexual activity). Interestingly, global sexual activity improved at 6 months but not at 12 months. Some domains of sexual life improved at 6 months (ie, desire, arousal, lubrication, satisfaction), but only desire remained improved at 12 months. CONCLUSIONS Abdominoplasty and lower body lift improve the quality of life of patients after massive weight loss and the sexual quality of life. This should be an additional valid reason for promoting reconstructive surgery for massive weight loss patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Yanis Berkane
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, and Shriners Children Boston
- Harvard Medical School
| | - François Saget
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud
| | - Elise Lupon
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU de Nice, Côte d'Azur University
| | - Camille Mocquard
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud
- INSERM U1236, University of Rennes 1
- SITI Laboratory, Rennes University Hospital
| | - Isabelle Pluvy
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU de Besancon, Franche-Comté University
| | - Eric Watier
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, and Shriners Children Boston
- Harvard Medical School
| | - Jérôme Duisit
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud
| | - Benoit Chaput
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Paul Sabatier University
| | - Nicolas Bertheuil
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud
- INSERM U1236, University of Rennes 1
- SITI Laboratory, Rennes University Hospital
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Antezana LA, Kreutz-Rodrigues L, Shapiro D, Chen A, Sharaf B, Martinez-Jorge J, Bakri K. Most Cited Articles in Body Contouring: A Bibliometric Analysis of the Past 45 Years. Plast Surg (Oakv) 2024; 32:265-275. [PMID: 38681248 PMCID: PMC11046267 DOI: 10.1177/22925503221120574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 05/01/2024] Open
Abstract
Introduction: The purpose of this study is to produce a bibliometric review of the 30 most cited articles related to 6 major domains of body contouring-abdominoplasty, thighplasty, brachioplasty, gluteoplasty, body lift, and liposuction-for resident and fellow education. Methods: The authors utilized the Web of Science Citation Index to identify the 30 most cited articles related to surgery for body contouring published from 1975 to 2020. Articles were classified according to their level of evidence, type of study, and country of publication. Results: A total of 336 articles were reviewed to compile our list. The mean number of citations across the articles was 114.7 ± SD 86.1. The highest prevalence of the papers was published between 2000 and 2009 (n = 15, 50%). The country with the highest number of contributions was the United States (n = 22, 73%). Plastic and Reconstructive Surgery served as the main journal of publication for these papers (n = 22, 73.3%). The majority of articles were designated for clinical-type studies (n = 26, 86.7%). No basic science or prevalence study design papers were listed. In terms of level of evidence (LoE), most papers were assigned IV (n = 11, 36.7%) and III (n = 7, 23.3%). Conclusions: Our study reveals that the most cited papers in body contouring are of LoE III and IV. Although the LoE of plastic surgery research, in general, has improved, in the past decade, a call for higher quality papers remains. Overall, this analysis provides an easy, electronic starting point for residents and fellows interested in understanding the field's evolution.
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Affiliation(s)
| | | | - Daniel Shapiro
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Austin Chen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Basel Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Chen N, Daly TK, Ooi WM. Panniculectomy for a Rare End-Stage Complication of Severe Obesity and Increasing Surgical Phenomenon. Cureus 2024; 16:e57592. [PMID: 38707026 PMCID: PMC11069328 DOI: 10.7759/cureus.57592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Panniculus morbidus (PM) is a presentation of severe chronic abdominal lymphoedema associated with obesity resulting in oedema and chronic fibrosis. It is a multifaceted condition with significant clinical and psychosocial implications. A 29-year-old female weighing 260 kg with a body mass index of 95 kg/m2 had recurrent infections and sepsis associated with an abdominal pannus extending to her knees and an area of ulceration. The pannus was indurated with extensive fibrosis that significantly affected her quality of life (QOL) requiring assistance for all activities of daily living (ADLs). A panniculectomy was performed with a negative pressure skin dressing over the skin wound. She was discharged after two days. Two months postoperatively, she reported significant improvement in QOL and can now mobilise and perform ADLs independently with no recurrent admissions. The global prevalence of obesity is reaching pandemic proportions and so will its complications. It can be functionally debilitating and worsen obesity. Surgical resection is indicated to restore mobility and function, prevent recurrent infections, improve QOL, and reduce economic burden. Patients report high satisfaction rates following surgery. Panniculectomy is an effective treatment to alleviate morbidity in severe obesity and should be considered in patients with recurrent infections and a significant impact on QOL.
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Affiliation(s)
- Nelson Chen
- General Surgery, Northern Hospital Epping, Melbourne, AUS
| | - Tessa K Daly
- General Surgery, Northern Hospital Epping, Melbourne, AUS
| | - Wei Ming Ooi
- General Surgery, Northern Hospital Epping, Melbourne, AUS
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Malkoc A, Landau MJ, Shoemaker H, Leong DSM, Chang WT. Novel use and utilization of robotic Hoyer-Hook system for suspension of panniculus morbidus. JPRAS Open 2023; 37:87-91. [PMID: 37457989 PMCID: PMC10339113 DOI: 10.1016/j.jpra.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Panniculus morbidus is a complication of morbid obesity characterized by massive abdominal folds that hang below the beltline. Ulceration, dermatitis, and sinus tract formation of the pannus can cause significant morbidity to the patient and impair activities of daily living. If patients fail medical management, the next step is surgical excision. Challenging aspects of the procedure include adequate suspension of the pannus, cost, and prevention of intra-abdominal injuries. We present a case of a 70-year-old female with panniculus morbidus with endometrial carcinoma. We successfully performed a panniculectomy using a novel combination of towel hooks and the Hoyer lift to suspend the abdomen. In the same anesthesia event, she underwent robotic-assisted hysterectomy. No intra-operative or post-operative complications were encountered, and the patient was satisfied with her results. In this case, we demonstrated an effective and cost-efficient approach to panniculectomy in the severely obese patient.
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Affiliation(s)
- Aldin Malkoc
- Department of General Surgery, Kaiser Permanente, Fontana, CA, USA
| | - Mark J. Landau
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Hailey Shoemaker
- Bernard J Tyson School of Medicine, Kaiser Permanente, Pasadena, CA, USA
| | | | - Walter T. Chang
- Department of Plastic Surgery, Kaiser Permanente, Fontana, CA, USA
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Winicki NM, Florissi IS, Michelotti MJ, Srikureja DP. Panniculus morbidus resection complicated by multiple gastrointestinal hernias: A case report. Ann Med Surg (Lond) 2022; 80:104177. [PMID: 36045791 PMCID: PMC9422187 DOI: 10.1016/j.amsu.2022.104177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Case presentation Clinical discussion Conclusion Panniculus morbidus incidence is increasing with the rise of morbid obesity. Gastrointestinal hernia repair is a challenging for patients with panniculus morbidus. Concomitant hernia repair and panniculectomy can be performed safely and effectively, enhancing weight loss and quality of life.
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Affiliation(s)
- Nolan M. Winicki
- University of California Riverside, School of Medicine, Riverside, CA, USA
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA
- Corresponding author. School of Medicine University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA.
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Abdominal Panniculectomy: An Analysis of Outcomes in 238 Consecutive Patients over 10 Years. Plast Reconstr Surg Glob Open 2021; 9:e3955. [PMID: 34840922 PMCID: PMC8613336 DOI: 10.1097/gox.0000000000003955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 01/09/2023]
Abstract
Panniculectomy is a commonly performed body contouring procedure to address skin laxity and its related complications. This study aimed to assess clinical outcomes of abdominal panniculectomy and identify predictors of complications at a tertiary academic healthcare center. Methods A retrospective review of patients who underwent panniculectomy between January 2010 and January 2020 at our institution was performed. Exclusion criteria were a history of prior panniculectomy or abdominoplasty. Patient characteristics and clinical outcomes were collected. Univariate and multivariable analyses were performed to assess the risk factors of complications. Results The mean age in the included 238 patients was 51.7 ± 12.7 years, and the mean body mass index (BMI) at the time of panniculectomy was 33 ± 7.5 kg/m2. Median resection weight was 2.7 kg (range: 0.15-14.6) and median length of hospital stay was 2 days (range: 0-24). Mean follow-up time was 50 ± 37 months. The rate of major complications was 22.3%. Revision surgery was performed in 3.4% of the cases. Multivariable analyses demonstrated that increase in BMI (P = 0.007) and active smoking (P = 0.026) were significantly associated with increased odds of major complication, and increase in BMI (P = 0.0004), history of venous thromboembolism (P = 0.034) and having a concomitant ventral hernia repair (P = 0.0044) were significantly associated with having a length of hospital stay of 3 days or more. Conclusions Panniculectomy is generally safe to perform, with major postoperative complication rate of 22.3% in our series. Increase in BMI and active smoking were significantly associated with having a major complication. Higher BMI, concomitant hernia repair, and a history of venous thromboembolism were associated with length of hospital stay of 3 days or more.
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Massive Localized Abdominal Lymphedema Treatment Challenges. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2601. [PMID: 32095405 PMCID: PMC7015591 DOI: 10.1097/gox.0000000000002601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/31/2019] [Indexed: 01/22/2023]
Abstract
Massive localized lymphedema of the abdomen is a rare condition resulting from a neglected lower abdominal pannus associated with significant disability and morbidity. Compared to other surgical procedures, postbariatric surgery is usually considered a financial drain. In the United Kingdom, this requires National Health Service approval and delays may lead to sequelae that adversely impact on patients' quality of life with increased morbidity. We present a wheelchair-bound patient whose body mass index increased from 53 to 82, while awaiting funding approval increasing her anesthetic and surgical risks. A multidisciplinary approach is mandatory for preoperative, intraoperative, and postoperative care for these patients including anesthetic input and high dependency unit care. Managing this patient was a significant anesthetic and surgical challenge with 47-kg resected tissue. The planning and perioperative measures to minimize morbidity are discussed.
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Validation of the American College of Surgeons National Surgical Quality Improvement Program Risk Model for Patients Undergoing Panniculectomy. Ann Plast Surg 2019; 83:94-98. [PMID: 30633014 DOI: 10.1097/sap.0000000000001759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Panniculectomy procedures have been reported to significantly improve quality of life, increase mobility, and improve hygiene in patients with a significant pannus formation. The primary aims of this study were to determine which preoperative risk factors may be used to differentiate postoperative complication rate among patient cohorts and to validate utilization of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator in patients undergoing panniculectomies. METHODS This retrospective study included all patients who underwent a panniculectomy procedure at our institution from 2005 to 2016. Baseline characteristics, preoperative risk factors, medical comorbidities, and postoperative complications were collected via retrospective chart review. RESULTS Two hundred sixty-four patients who underwent a panniculectomy were identified. The odds ratios of any postoperative complication were 8.26, 7.76, and 16.6 for patients with classes 1, 2, and 3 obesity, respectively (P < 0.05). Statistical modeling was utilized to evaluate the predictive performance of the ACS-NSQIP Surgical Risk Calculator. We calculated the C-statistic for the ACS-NSQIP model to be only 0.61, indicating that although the model is associated with the risk of complication, it does not have a strong predictive value for this particular procedure. DISCUSSION This study is one of the first to characterize postoperative complication rate based on extremum of body mass index for panniculectomy patients. Our results show that the utilization of the ACS-NSQIP Risk Calculator in this particular patient population underestimates the complication risk as a whole, which may necessitate the future development of a separate risk assessment model for this procedure.
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Smith OJ, Hachach-Haram N, Greenfield M, Bystrzonowski N, Pucci A, Batterham RL, Hashemi M, Mosahebi A. Body Contouring Surgery and the Maintenance of Weight-Loss Following Roux-En-Y Gastric Bypass: A Retrospective Study. Aesthet Surg J 2018; 38:176-182. [PMID: 29040424 DOI: 10.1093/asj/sjx170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient's functionality with potential negative effects on weight loss. OBJECTIVES We evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery. METHODS We undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/- body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (%WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups. RESULTS The %WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, %WL was 35.6% in the RYGB+BC group and 30.0% in the RYGB group (P < 0.05). At 36 months, the RYGB+BC group maintained their weight loss (%WL 33.0%), in contrast, the RYGB gained weight (%WL = 27.3%, P < 0.05). This trend continued (RYGB+BC vs RYGB) at 48 months (%WL 30.8% vs 27.0%) and at 60 months (%WL 32.2% vs 22.7%, P < 0.05). CONCLUSIONS Our results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone.
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Affiliation(s)
- Oliver J Smith
- NIHR Academic Clinical Fellow in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Nadine Hachach-Haram
- Specialty Registrars in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | | | - Nicki Bystrzonowski
- Specialty Registrars in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Andrea Pucci
- Consultant Obesity Physician, Centre for Obesity Research, Department of Medicine, University College, London, UK
| | - Rachel L Batterham
- Professor of Obesity, Diabetes, and Endocrinology, Centre for Obesity Research, Department of Medicine, University College, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College, London, UK
| | - Majid Hashemi
- Consultant Upper GI and Bariatric Surgeon, UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College, London, UK
| | - Afshin Mosahebi
- Consultant Plastic, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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Fadel MG, Chatzikonstantinou M, Gilchrist C, Andrews B. Panniculus morbidus: obesity-related abdominal wall lymphoedema. BMJ Case Rep 2017; 2017:bcr-2016-219023. [PMID: 28456757 DOI: 10.1136/bcr-2016-219023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old female patient presented with a massive abdominal wall swelling that adversely affected her lifestyle. Imaging revealed significant subcutaneous oedema and the presence of grossly distended veins. Subsequently, she underwent a 'toilet' panniculectomy and abdominoplasty. We describe the surgical technique used to retract the lymphoedematous tissue facilitating excisional surgery, and discuss the pathophysiology of this condition and the possible contribution of venous obstruction to the development of subcutaneous oedema.
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Affiliation(s)
| | | | | | - Brian Andrews
- General Surgery and Vascular Surgery, Medway Maritime Hospital, Gillingham, UK
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Guerra S. C, Yáñez M. R. ACTUALIZACIÓN EN CONTORNO CORPORAL POSBARIÁTRICO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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