Abdominoplasty After Massive Weight Loss

Retrograde Umbilical Hernia Repair During Abdominoplasty: A Safe and Simple Technique

BACKGROUND

Abdominoplasties are a very common procedure that is geared toward improving the abdominal contour and restoring quality of life. Main candidates for surgery are postpartum patients and patients after massive weight lost results in excess skin. The high incidence of umbilical hernias in the general population raises the question of whether combining its repair with cosmetic abdominoplasties is a safe and effective procedure.

PURPOSE

Determine the safety of the "retrograde umbilical hernia" (RUH) technique, which utilizes a pre-peritoneal approach to the hernia, during abdominoplasty procedure and expand the literature on hernia repair during aesthetic abdominal surgery.

METHODS

This is the retrospective cohort study of all patients that underwent abdominoplasty by the senior author. Eligible patients were divided into 2 groups: where one group included all patients who underwent abdominoplasty with RUH repair, and the second group underwent sole abdominoplasty. Baseline variables, surgical notes, and post-operative outcomes were obtained from the patients' medical records and analyzed for the purpose of this study.

RESULTS

In total, 744 patients underwent abdominoplasties during the course of our study, 112 of which underwent concomitant umbilical hernia repair using the retrograde technique. The RUH technique was not found to result in a higher rate of complications compared to a similar population of traditional abdominoplasties.

CONCLUSIONS

The retrograde umbilical hernia repair is a safe and efficient technique that can be easily implemented during abdominoplasty procedures in a heterogeneous population of patients.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Experience in Post-Bariatric Abdominoplasty for Patients with Significant Weight Loss: A Prospective Study

BACKGROUND

Abdominoplasty is a critical aesthetic and functional procedure for individuals who have undergone massive weight loss. Numerous techniques have been proposed to optimize aesthetic results while minimizing complications.

METHODS

This prospective study examined 500 patients who underwent abdominoplasty during body-contouring procedures between 1 January 2018 and 31 December 2021 at a tertiary center. The Skin-Adipose Tissue-Muscle (SAM) protocol was employed to analyze the operative strategies and complication rates and compare them with the existing literature. Furthermore, patient satisfaction and aesthetic outcomes were measured one year post-operation using a comprehensive four-point questionnaire evaluated by the patients themselves and two independent surgeons.

RESULTS

Participants had an average age of 34.8 years and a mean BMI of 31.1 kg/m2. The surgeries included 328 full abdominoplasties and 172 T-inverted abdominoplasties. Notable complications included wound infection (4%), wound dehiscence (8.6%), tissue necrosis (0.6%), seroma (8.4%), and hematoma (2.6%). A higher BMI was correlated with an increased risk of complications and lower patient satisfaction. Data analysis was performed using Stata version 18 software.

CONCLUSIONS

The increasing prevalence of obesity highlights an urgent need for more bariatric surgeries and subsequent abdominoplasties to mitigate the effects of massive weight loss. A crucial link between elevated BMI and a heightened risk of postoperative complications, emphasizing the necessity for standardized surgical protocols tailored to individuals with higher BMI, was noted. Innovatively, future studies must further investigate the intricate dynamics between BMI and surgical risks. Exploring and establishing uniform, adaptive surgical guidelines promise to revolutionize patient care by significantly reducing complications and enhancing recovery and satisfaction following abdominoplasty.

Comorbid Conditions and Complications in Body Contouring Surgery: A Retrospective Review

Background

Body contouring procedures have significantly increased in popularity in the United States.

Objectives

The authors sought to understand, categorize, and classify patients' experiences with postoperative complications following common body contouring procedures.

Methods

PearlDiver (PearlDiver Technologies, Colorado Springs, CO), a database with over 90 million patients, was queried to identify patients who had undergone body contouring procedures between 2010 and 2021 using current procedural terminology (CPT) codes. The authors identified patients who underwent panniculectomy, abdominoplasty, brachioplasty, thighplasty, mastopexy, breast augmentation, augmentation mastopexy, breast reduction, and liposuction for analysis. They reviewed combined procedures and analyzed risk factors associated with the most common complications.

Results

There were 243,886 patients included in the study. The majority of patients were female, between 50 and 59 years old, and had their procedures performed in the southern United States. There were an average of 25,352 procedures per year. The majority of cases involved breast surgeries. The most common preoperative comorbid conditions diagnosed 1 year before surgery were hypertension, obesity, and diabetes. The most common postoperative complications within 90 days were wound dehiscence, hematoma, and urinary tract infection. A logistic regression evaluating the association of the preoperative comorbid conditions with postoperative complications found that patients with obesity, tobacco use, diabetes, and hypertension had an increased risk of developing wound dehiscence, hematoma, and surgical-site infection.

Conclusions

The data suggest that patients with obesity, tobacco use, diabetes, and hypertension undergoing body contouring surgery are at greater risk of developing wound dehiscence, hematomas, and surgical-site infections. Understanding this data is imperative for providers to adequately identify associated risk factors, stratify patients, and provide adequate perioperative counseling.

Level of Evidence 2

Panniculectomy as a surgical option for the management of a deep surgical site infection after C-section in a morbidly obese woman: a case report

BACKGROUND

Obesity is an independent risk factor for the occurrence of surgical site infections (SSIs) following all types of surgeries, especially after Caesarean section (C-section). SSIs increase postoperative morbidity, health economic cost and their management is quiet complex with no universal therapeutic consensus. Herein, we report a challenging case of a deep SSI after C-section in a central morbidly obese woman managed successfully by panniculectomy.

CASE PRESENTATION

A 30-year-old black African pregnant woman with marked abdominal panniculus extending to the pubic area, a waist circumference = 162 cm and BMI = 47.7 kg/m² underwent an emergency CS indicated for acute fetal distress. By day five post-operation, she developed a deep parietal incisional infection unremitting to antibiotic therapy, wound dressings and beside wound debridement till the 26th postoperative day. A large abdomen panniculus and maceration of the wound enhanced by central obesity increased the risk of failure of spontaneous closure; thus, an abdominoplasty by panniculectomy was indicated. The patient underwent panniculectomy on the 26th day after the initial surgery and her post-operative course was uneventful. Wound esthetics was satisfactory three months later. Adjuvant dietary and psychological management were associated.

CONCLUSION

Post-Caesarean deep SSI is a frequent complication in obese patients. A panniculectomy may be a safe and promising therapeutic surgical option with good cosmetic results and little postoperative complications when used in a multidisciplinary anti-obesogenic approach.

Avoidance and Correction of Deformities in Body Contouring

Body contouring procedures are highly impactful because of their potential to improve a patient's quality of life. These procedures, particularly when performed on patients following massive weight loss, may require secondary intervention to treat residual contour abnormalities. Presently, there is a paucity of information in the literature detailing the avoidance and correction of body contouring deformities. Herein, we will discuss the management of patients seeking revisional body contouring procedures.