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Pollhammer MS, Duscher D, Pagani A, Zaussinger M, Wenny R, Zucal I, Schmidt M, Prantl L, Huemer GM. The Clavien-Dindo Classification for Body-Contouring Surgery Complications: Evaluation of 602 Cases. Life (Basel) 2024; 14:1120. [PMID: 39337903 PMCID: PMC11432988 DOI: 10.3390/life14091120] [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: 08/03/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Due to the high frequency of postoperative complications after body-contouring surgeries, the need for a unifying postoperative complication grading system that correlates with outcomes is of key importance. Here we therefore consider the application of the Clavien-Dindo classification to evaluate postoperative complications after body-contouring surgeries. Methods: A retrospective study on 602 patients who underwent body-contouring surgery between 2009 and 2015 at our institution was performed. The length of hospital stays, age, sex, follow-up visits, and postoperative complications were evaluated and classified using the Clavien-Dindo classification. Results: We raised a total of 672 body-contouring procedures on 602 patients (563 female, 39 male). According to the Clavien-Dindo System, the severity of postoperative complications following body-contouring procedures was significantly correlated with the duration of hospitalization (mean 5.8 ± 2.7 days) and the number of follow-up visits (mean 4.4 ± 4.7). Conclusions: The Clavien-Dindo classification offers a valid prediction for postoperative hospital stay and the number of follow-up visits after body-reshaping surgery. By becoming a validated and reliable grading system that correlates patients' outcomes after body-contouring procedures, this classification has the potential to significantly improve patients' healthcare and quality of life.
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Affiliation(s)
- Michael S Pollhammer
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
| | - Dominik Duscher
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospital of Regensburg, Franz-Josef S. Allee 11, 93053 Regensburg, Germany
| | - Andrea Pagani
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospital of Regensburg, Franz-Josef S. Allee 11, 93053 Regensburg, Germany
| | - Maximilian Zaussinger
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
- Doctoral Degree Program in Medial Science (Ph. D.), Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Raphael Wenny
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
| | - Isabel Zucal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Manfred Schmidt
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
| | - Lukas Prantl
- Department of Plastic, Reconstructive & Aesthetic Surgery, University Hospital of Regensburg, Franz-Josef S. Allee 11, 93053 Regensburg, Germany
| | - Georg M Huemer
- Section of Plastic, Aesthetic & Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstraße 9, 4020 Linz, Austria
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van Uittert G, Hoogbergen M, Beaudart C, Li N, Boers M, Hiligsmann M. Patients' health related quality of life after massive weight loss reconstruction in the Netherlands. Expert Rev Pharmacoecon Outcomes Res 2024:1-10. [PMID: 39158932 DOI: 10.1080/14737167.2024.2393328] [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: 12/07/2023] [Revised: 07/08/2024] [Accepted: 08/04/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES The present study aimed to evaluate the impact of undergoing massive weight loss reconstruction (MWR) on health-related quality of life (HR-QoL) in the Netherlands. METHOD A retrospective study was performed among 131 Dutch bariatric patients, divided into two groups: an intervention group (93 patients who had undergone MWR) and a control group (38 patients who had not undergone MWR). HR-QoL was assessed by the validated BODY-q questionnaire. The sign test was used to measure the difference between the 0 and 12 months' measurements of HR-QoL in both groups, whereas multiple regression analysis was conducted to assess whether undergoing MWR significantly predicted participants' incremental HR-QoL. RESULTS Whereas the intervention group showed a significance improvement on all parameters of the BODY-q between 0 and 12 months (all parameters p < .001), the control group did not. The multiple regression analysis showed that having undergone a MWR significantly and positively predicted incremental HR-QoL on all scales on the BODY-q (all parameters p < 0.05). CONCLUSION The present study suggests a positive impact of MWR on the HR-QoL of bariatric patients.
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Affiliation(s)
- Guus van Uittert
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Maarten Hoogbergen
- Department Plastic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Charlotte Beaudart
- Namur Research Institute for Life Sciences (NARILIS), Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
- Department of Health Services Research - Faculty of Medicine, University of Namur, Namur, Belgium
| | - Nannan Li
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mijke Boers
- Department Plastic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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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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Facchin F, Pagani A, Perozzo FAG, Scarpa C, Bassetto F, Vindigni V. Litigation Cases After Post-Bariatric Surgery: Lesson from the Past. Aesthetic Plast Surg 2023; 47:2479-2485. [PMID: 36820862 PMCID: PMC10784373 DOI: 10.1007/s00266-023-03287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Due to the high demand of post-bariatric surgeries, the number of litigation cases is rapidly growing. Even if surgical mistakes still represent one of the main causes of medico-legal issues, many disputes depend on what happens in the post-operative course. In this article we analyzed the litigation cases that occurred in our Plastic Surgery Department, the current literature about medico-legal disputes and the importance of the doctor-patient relationship. PATIENTS AND METHODS The medical records of 788 post-bariatric surgeries, the post-operative complications and the related litigation cases from January 2015 to December 2019 were collected, analyzed and compared. RESULTS We performed 380 abdominoplasties, 28 torsoplasties, 65 breast reductions, 99 mastopexies, 94 brachioplasties, 52 thighplasties, 65 liposuctions and 5 facelifts between 2015 and 2019. Eight patients complained of medical issues and claimed for litigation. Despite in all cases the judges highlighted the risk of consent misinterpretation, the payout was granted only in one case. CONCLUSION Post-bariatric patients often mistake their preoperative condition and consider body contouring procedures as an aesthetic surgery treatment. Patients should be therefore clearly informed about the complexity of body contouring procedures after massive weight loss, which should never be compared to aesthetic surgery. Surgeons should always promote the communication with their patients and build a strong and trustworthy relationship. This attitude will allow to deal more easily with complications and, in the worst situations, with medico-legal litigations. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Federico Facchin
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
- Plastic Surgery Unit, San Bortolo Hospital, 36100, Vicenza, Italy.
| | - Andrea Pagani
- Clinic and Polyclinic of Plastic and Hand Surgery, Technical University of Munich, 81675, Munich, Germany
| | - Filippo Andrea Giovanni Perozzo
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Carlotta Scarpa
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Ribeiro ASP, Marquezin MCS, Pacheco ERP, Rasera I, Klein MI, de Vasconcellos SP, Landgraf RG, Okamoto D, Calixto LA, Castelo PM. Bypass gastroplasty impacts oral health, salivary inflammatory biomarkers, and microbiota: a controlled study. Clin Oral Investig 2023; 27:4735-4746. [PMID: 37294353 DOI: 10.1007/s00784-023-05101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Knowledge about the impact of gastroplasty on oral health and salivary biomarkers is limited. The aim was to prospectively evaluate oral health status, salivary inflammatory markers, and microbiota in patients undergoing gastroplasty compared with a control group undergoing a dietary program. MATERIALS AND METHODS Forty participants with obesity class II/III were included (20 individuals in each sex-matched group; 23-44 years). Dental status, salivary flow, buffering capacity, inflammatory cytokines, and uric acid were assessed. Salivary microbiological analysis (16S-rRNA sequencing) assessed the abundance of genus, species, and alpha diversity. Cluster analysis and mixed-model ANOVA were applied. RESULTS Oral health status, waist-to-hip ratio, and salivary alpha diversity were associated at baseline. A subtle improvement in food consumption markers was observed, although caries activity increased in both groups, and the gastroplasty group showed worse periodontal status after three months. IFNγ and IL10 levels decreased in the gastroplasty group at 3 months, while a decrease was observed in the control group at 6 months; IL6 decreased in both groups (p < 0.001). Salivary flow and buffering capacity did not change. Significant changes in Prevotella nigrescens and Porphyromonas endodontalis abundance were observed in both groups, while alpha diversity (Sobs, Chao1, Ace, Shannon, and Simpson) increased in the gastroplasty group. CONCLUSIONS Both interventions changed in different degrees the salivary inflammatory biomarkers and microbiota, but did not improve the periodontal status after 6 months. CLINICAL RELEVANCE Although the observed discrete improvement in dietary habits, caries activity increased with no clinical improvement in the periodontal status, emphasizing the need of oral health monitoring during obesity treatment.
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Affiliation(s)
- Aianne Souto Pizzolato Ribeiro
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil
| | - Maria Carolina Salomé Marquezin
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil
| | | | - Irineu Rasera
- Faculdade de Ensino Superior da Amazônia Reunida, Av. Brasil, 1435, Redenção, Brazil
| | - Marlise Inês Klein
- Faculdade de Odontologia de Piracicaba, Universidade de Campinas, Av. Limeira, 901, Piracicaba, Brazil
| | - Suzan Pantaroto de Vasconcellos
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil
| | - Richardt Gama Landgraf
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil
| | - Debora Okamoto
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil
| | - Leandro Augusto Calixto
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil
| | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), R. São Nicolau, 210 - 1. Andar, Diadema, SP, Brazil.
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Barbaro A, Kumar A, Asokan G, Green L, Ibrahim A, Goel R, Harries R, Kanhere H, Prowse P, Trochsler M. Quality of Life After Bariatric and Body Contouring Surgery in the Australian Public Health System. J Surg Res 2023; 285:76-84. [PMID: 36652771 DOI: 10.1016/j.jss.2022.12.037] [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: 07/24/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The goals of bariatric surgery are weight loss, improved management of obesity-related diseases, and enhanced health-related quality of life (HRQoL). The aim of this study is to determine HRQoL among postoperative bariatric surgery patients. The aim of this study was to evaluate the utility of bariatric surgery and the role of body contouring surgery (BCS) when considering quality of life in low-volume centres in the Australian public health system. METHODS This cohort study compared patients who underwent bariatric surgery between 2008 and 2018, to those awaiting surgery. An additional analysis was completed for patients who also underwent BCS. Patients completed the Short Form-36 quality of life (SF-36) survey. Linear regression was used to assess the differences in mean scores between cohorts for each of the SF-36 domains. RESULTS A total of 131 postoperative patients were identified, with a follow up rate of 68%. The mean follow up was 5.4 y. The mean scores for all domains of the SF-36 in the postoperative group were higher than the preoperative group (P ≤ 0.0001). A significant difference in scores persisted after controlling for patients' current BMI. When considering patients who underwent BCS (n = 24), there was a further global improvement in HRQoL in physical function (P = 0.0065), role limitation to physical health (P = 0.0026), pain (P = 0.0004), energy (P = 0.0023) and general health perceptions (P = 0.0023). CONCLUSIONS Bariatric surgery followed by BCS may improve HRQoL for the patient when compared to bariatric surgery alone. We advocate for the use of bariatric surgery followed by BCS in low-volume centres in the Australian public health system.
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Affiliation(s)
- Antonio Barbaro
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Ajan Kumar
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Gayatri Asokan
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Luke Green
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Abdullah Ibrahim
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Raghav Goel
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Richard Harries
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Harsh Kanhere
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Phoebe Prowse
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Markus Trochsler
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia.
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Scarpa Fascia Preservation to Reduce Seroma Rate on Massive Weight Loss Patients Undergoing Abdominoplasty: A Comparative Study. J Clin Med 2023; 12:jcm12020636. [PMID: 36675566 PMCID: PMC9862610 DOI: 10.3390/jcm12020636] [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] [Received: 12/06/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
(1) Background: An increasing number of patients undergo bariatric surgery and seek body contouring surgery after massive weight loss (MWL). Abdominoplasty itself is associated with a high complication rate in these patients, particularly due to seroma formation. Scarpa fascia preservation (SFP) has been proven to be an efficient method of reducing seroma rates. We aimed to evaluate the possible benefits of SFP on massive weight loss patients comparatively. (2) Methods: This is a single-center retrospective comparative study encompassing 202 MWL patients operated between 2009 and 2019 at Turku University Hospital. Patients included in the study had a preoperative weight loss greater than 30 kg. Of them, 149 went through traditional abdominoplasty and 53 abdominoplasties with SFP. The primary outcome measure was seroma occurrence, while secondary outcomes included drainage amount, hospital stay, surgical site occurrence, and need for blood transfusion. (3) Results: The only statistically significant difference between groups on patients' demographics was the sex ratio, favoring females in the control group (43:10, 81% vs. 130:19, 87%, p = 0.018). SFP significantly reduced seroma occurrence (9.4% vs. 26.2%, p = 0.011) and decreased mean drainage duration (3.7 ± 2.4 vs. 5.3 ± 3.2 days, p = 0.025). There was a trend towards lower drainage output (214.1 ± 162.2 mL vs. 341.9 ± 480.5 mL, p = 0.060) and fewer postoperative days on ward in the SFP group. Other complication incidences did not differ between the groups. The multivariable analysis did not show any significant factor for seroma formation or surgical site occurrence. (4) Conclusions: Preserving Scarpa fascia on MWL patients may result in decreased seroma occurrence and a shorter time to drain removal.
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Recognition and repair of an incidental umbilical hernia repair during abdominoplasty. Ann Med Surg (Lond) 2022; 82:104731. [PMID: 36268346 PMCID: PMC9577829 DOI: 10.1016/j.amsu.2022.104731] [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: 07/09/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Umbilical hernias are found in 2% of the American adult population with increasing prevalence in overweight and multiparous women. A mesh repair is considered to be a suitable option for those desiring non-cosmetic surgical repair. Despite the mesh plug's reported value in reduction of the recurrence of umbilical hernia from 11% to 1%, there is an increased risk in de-vascularizing the umbilicus with its use. Presentation of Case We present a case which avoids fascial incisions near the umbilicus, thus preserving the blood supply employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication. Discussion of Case Hernia repair can be associated with a host of issues, minor and major, including regional tissue ischemia and the distortion of natural anatomy, likely due to ischemia of the epigastric vessels. Abdominoplasty is a suitable option for patients with redundancy of the abdominal skin and laxity abdominal wall musculature. Abdominoplasty has excellent exposure and correction of abdominal wall hernias. This “anatomic repair” employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication can be used in place of a mesh overlay for the purposes of umbilical hernia repair especially when the hernia may be asymptomatic. Conclusion Abdominoplasty uniquely allows for an open hernia repair when anticipated or discovered at the time of surgery and is considered a true anatomical repair of an umbilical hernia which does not necessitates the use of foreign materials. Umbilical hernias often remain undiscovered on physical exam prior to abdominoplasty. Special care should be taken around area of an umbilicus during an abdominoplasty due to risk of hernia perforation and umbilical devascularization. Abdominoplasty should be recommended over panniculectomy for patients with a known history of an umbilical hernia. Abdominoplasty should be considered in the treatment of umbilical hernias when weighted against an umbilical hernia repair using a mesh.
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Bigarella LG, Ballardin AC, Couto LS, de Ávila ACP, Ballotin VR, Ingracio AR, Martini MP. The Impact of Obesity on Plastic Surgery Outcomes: A Systematic Review and Meta-analysis. Aesthet Surg J 2022; 42:795-807. [PMID: 35037936 DOI: 10.1093/asj/sjab397] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory. OBJECTIVES The aim of this study was to summarize and clarify the divergences in the literature to provide a better understanding of the impact of obesity in different plastic surgery procedures. METHODS We conducted a systematic review and meta-analysis of the impact of obesity on plastic surgery outcomes. Searches were conducted in MEDLINE, LILACS, SciELO, Scopus, Embase, Web of Science, Opengrey.eu, and the Cochrane Database of Systematic Reviews. The primary outcomes assessed were surgical complications, medical complications, and reoperation rates. The secondary outcome assessed was patient satisfaction. Subgroup analysis was performed to investigate the impact of each BMI category on the outcomes. RESULTS Ninety-three articles were included in the qualitative synthesis, and 91 were used in the meta-analysis. Obese participants were 1.62 times more likely to present any of the primary outcomes (95% CI, 1.48-1.77; P < 0.00001). The highest increase in risk among plastic surgery types was observed in cosmetic procedures (risk ratio [RR], 1.80; 95% CI, 1.43-2.32; P < 0.00001). Compared with normal-weight participants, overweight participants presented a significantly increased RR for complications (RR, 1.16; 95% CI, 1.07-1.27; P = 0.0004). Most authors found no relation between BMI and overall patient satisfaction. CONCLUSIONS Obesity leads to more complications and greater incidence of reoperation compared with nonobese patients undergoing plastic surgeries. However, this effect is not evident in reconstructive surgeries in areas of the body other than the breast.
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Affiliation(s)
| | | | - Luísa Serafini Couto
- School of Medicine, Universidade de Caxias do Sul (UCS) , Caxias do Sul , Brazil
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Makarawung D, Al Nawas M, Smelt H, Monpellier V, Wehmeijer L, van den Berg W, Hoogbergen M, Mink van der Molen A. Complications in post-bariatric body contouring surgery using a practical treatment regime to optimise the nutritional state. JPRAS Open 2022; 34:91-102. [PMID: 36211632 PMCID: PMC9535379 DOI: 10.1016/j.jpra.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Post-bariatric body contouring surgery (BCS) treats redundant skin after massive weight loss; however, the complication risk is relatively high (23-70%). Most complications are wound-related, which may be partly due to a poor nutritional status after bariatric surgery. The objective of this observational study was to optimise nutrition preoperatively and assess the prevalence of wound-related complications after BCS. Methods This prospective cohort study included 140 patients. Patients were treated according to the post-bariatric BCS guideline. Nutritional parameters were collected via pre- and peri-operative blood sampling; any deficiencies were treated. A protein-enriched diet was prescribed by a dietician 4 weeks preoperatively up until closure of all wounds. Complications were recorded using the Clavien-Dindo classification. Univariate and multivariate regression analyses were performed to identify variables associated with wound-related complications. Results The overall wound-related complication rate was 51%. Most complications were minor, with only 4.3% was considered major. No significant differences in patient characteristics were found between patients with and without complications. Variables indicating an optimised nutritional state were not significantly associated with a decreased risk of complications; the most influential factor was a sufficient post-operative protein intake (OR 0.27, 95% CI 0.07 – 1.02, p = 0.05). Conclusion The overall wound-related complication rate was in accordance with previous literature; however, major complications were few. This study showed a weak correlation between optimising nutritional state and better outcome after BCS, especially following a protein-enriched diet post-operatively. Therefore, we recommend continuing research on nutrition and wound-related complications, using homogeneous study populations and well-defined complications.
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Affiliation(s)
- D.J.S. Makarawung
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - M. Al Nawas
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - H.J.M. Smelt
- Department of General Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - V.M. Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - L.M. Wehmeijer
- Department of Plastic, Reconstructive and Hand Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - W.B. van den Berg
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - M.M. Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - A.B. Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- Corresponding author. Aebele B. Mink van der Molen, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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11
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Dean NR, Foley K, Long R, Ward P. Experiences of women undergoing abdominoplasty in the public sector: a qualitative study. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: This study was designed to improve understanding of the experiences of women un-dergoing abdominoplasty in a public hospital setting, including their experience of processes of care, surgical treatment and outcomes of surgery.
Methods: This was a prospective, qualitative study, with one-to-one interviews with women, tran-scription of interviews and development of themes.
Results: Twenty interviews were carried out with 16 women, with four women being interviewed before and after surgery and the remaining 12 being interviewed one time only. Messages emerging from the interviews included gratitude for treatment in the public sector, uncertainty associated with waiting times and surgeon allocation, and varied satisfaction with outcomes. This article also explores the evidence for the association between physical symptoms and rectus diastasis (separa-tion of the rectus abdominis muscles) as well as mental health improvement.
Conclusion: Women undergoing abdominoplasty in the public sector are not a homogenous group, either in their motivations for surgery or their reported outcomes. This qualitative study found evidence for improvement in physical symptoms and psychological wellbeing in women undergoing abdominoplasty, which supports existing quantitative studies, but also highlights a need for clear information for public sector patients, especially relating to scars, and for liaison psy-chiatry. Criteria-based assessment contributes an additional burden for these patients.
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12
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Marouf A, Mortada H. Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2810-2820. [PMID: 34018015 DOI: 10.1007/s00266-021-02315-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is a major global health problem. With an increasing number of bariatric surgeries, the need for body-contouring procedures has grown. These procedures are associated with multiple complications because of various patient characteristics and risk factors. OBJECTIVES In this study, we performed a systematic literature review of all the complications of postbariatric body contouring surgeries, as well as a meta-analysis to estimate the effects of body mass index (BMI) and the weight of the tissue resected during body contouring on the development of complications. METHODS We conducted a literature search of the PubMed and Cochrane databases in September 2020, using the MeSH terms plastic surgery, weight loss, and complications. Studies were included if they involved more than 35 postbariatric patients and reported postoperative complication rates and types. RESULTS In total, 561 articles were initially identified, and 25 studies were included after the final review. The overall weighted rate of postbariatric body contouring surgical complications in all studies was 31.5%. The most frequent complication from all regions of body contouring was seroma (weighted rate 12.7-13.9%). Regarding risk factors, analysis indicated that a BMI < 30 kg/m2 and low mean weight of resected tissue were associated with fewer complications. CONCLUSION Body contouring procedures are relatively safe. Although complications after contouring are common, most either resolve spontaneously or require minimal intervention. In body contouring after bariatric surgery, there is a 37% increased risk of developing complications if the BMI is ≥ 30 kg/[Formula: see text] before body contouring. A higher weight of resected tissue appears to be linked to a greater risk of complications. 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 .
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Affiliation(s)
- Azmi Marouf
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
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13
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Simunovic F, Bonaventura B, Schneider L, Horner VK, Weber J, Stark GB, Kalash Z. The Edmonton Obesity Staging System Predicts Postoperative Complications After Abdominoplasty. Ann Plast Surg 2021; 87:556-561. [PMID: 34699434 DOI: 10.1097/sap.0000000000002814] [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: 11/25/2022]
Abstract
BACKGROUND This study investigates the relationship between Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after abdominoplasty in massive weight loss patients. METHODS A single-institution retrospective review of patients undergoing abdominoplasty between 2009 and 2019 after massive weight loss. Demographic data, laboratory findings, known risk factors for postoperative complications, as well as data on major and minor complications were extracted from the patient charts. Logistic regression models were used to investigate the relationship between the variables. RESULTS Four hundred and five patients were included in the study. The prevalence of EOSS stages was: 0 (no comorbidities, N = 151, 37%), 1 (mild conditions, N = 40, 10%), 2 (moderate conditions, N = 149, 36%) and 3 (severe conditions, N = 70, 17%). Regression analysis showed that, controlling for body mass index (BMI), BMI Δ (maximal BMI - BMI at presentation), bariatric surgery, volume of resected tissue, and duration of surgery, EOSS stage significantly associated with the occurrence of postoperative complications. Compared with EOSS stage 0, EOSS stages 2 and 3 patients were associated with significantly more minor and major complications, respectively. The volume of resected tissue, BMI Δ, and age were associated with the occurrence of major complications. A regression model of comorbidities comprising the EOSS revealed a significant association of variables diabetes mellitus and hypertension with the occurrence of postoperative complications. CONCLUSIONS Edmonton Obesity Staging System is a robust predictor of postoperative complications in abdominoplasty.
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Affiliation(s)
- Filip Simunovic
- From the Department of Plastic and Hand Surgery, Freiburg University Medical Center, Freiburg, Germany
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14
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Edmondson SJ, Ross DA. The postpartum abdomen: psychology, surgery and quality of life. Hernia 2021; 25:939-950. [PMID: 34309770 DOI: 10.1007/s10029-021-02470-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The postpartum abdomen presents significant challenges to the surgeon. It is anatomically complex, with often substantial symptomatic divarication of the rectus abdominis, affecting all anterior abdominal wall layers. This may lead to profound functional sequelae, and often, of more importance to patients, a significant physical deformity. The complex interplay of functional/physical symptoms can result in reduced quality of life (QoL) as well as negative body image/self-esteem. Postpartum women may seek abdominoplasty to address the whole scope of these concerns. Whilst techniques have evolved achieving such goals operatively, the impact of such surgery on QoL/mental health has yet to be established. METHODS We perform a comprehensive review of potential options of validated patient-reported outcome measures (PROMs) for consideration of use in postpartum women seeking abdominoplasty; in addition to discussing current driving factors for seeking surgery and associated ethics. RESULTS Pressure on postpartum women to return their abdominal wall contour to a pre-pregnant state is high. This poses important ethical considerations for surgeons. There are several well-established/validated PROMs used in body contouring in massive weight loss/bariatric population groups, including Body-Q and Body-QoL scales, but none yet specific to postpartum women. CONCLUSION PROMs use to enable establishment of the true value of abdominoplasty in postpartum women, not just in terms of functional/physical restoration, but also in terms of delivering a positive impact on patients' mental health and QoL, are important. Further research is needed to determine if those already developed are appropriate or whether a postpartum-specific PROM would be beneficial.
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Affiliation(s)
- S-J Edmondson
- Plastic and Reconstructive Surgery Department, The London Clinic, 20 Devonshire Place, London, W1G 6BW, England.
| | - D A Ross
- Plastic and Reconstructive Surgery Department, The London Clinic, 20 Devonshire Place, London, W1G 6BW, England
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15
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De Paep K, Van Campenhout I, Van Cauwenberge S, Dillemans B. Post-bariatric Abdominoplasty: Identification of Risk Factors for Complications. Obes Surg 2021; 31:3203-3209. [PMID: 33796972 DOI: 10.1007/s11695-021-05383-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim was to evaluate the complication rate after abdominoplasty procedures performed in a high volume post-bariatric center and to identify predictors of complications. MATERIAL AND METHODS A retrospective analysis was performed and included all abdominoplasty procedures performed between January 2011 and December 2019. Complications classified according to the Clavien-Dindo classification were documented and potential risk factors were statistically evaluated. RESULTS A total of 898 patients were included. Overall complication rate was 29.8%. Type I complications (minor wound problems) occurred in 15.8% (n = 140). Type II complications requiring medical intervention occurred in 10% (n = 90). Five patients had deep venous thrombosis or pulmonary embolism; others received antibiotic treatment for wound infections. In total 42 type III complications occurred in 36 patients, with re-intervention for wound problems (n = 16), seroma (n = 16), umbilical necrosis (n = 4), and bleeding (n = 6). The weight of tissue resected (p < 0.001), the interval between bariatric and body contouring surgery (p < 0.05), preoperative BMI (p < 0.05), male gender (p < 0.05), diabetes mellitus type 2 (p = 0.05), and smoking (p < 0.05) were important predictors for developing complications. CONCLUSION In this large retrospective post-bariatric abdominoplasty series, the overall complication rate is low compared to other published series as a consequence of our completely standardized approach and technique. Our analysis shows a significant linear correlation between the amount of skin tissue resected and postoperative complications. Moreover, the longer the interval between bariatric surgery and abdominoplasty, the higher the complication rate. High preoperative BMI, diabetes mellitus type 2, smoking, and male gender were identified as independent significant risk factors for complications.
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Affiliation(s)
- Karen De Paep
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| | - Ilia Van Campenhout
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| | - Sebastiaan Van Cauwenberge
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium.
| | - Bruno Dillemans
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
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O’Kelly N, Nguyen K, Gibstein A, Bradley JP, Tanna N, Matarasso A. Standards and Trends in Lipoabdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3144. [PMID: 33173672 PMCID: PMC7647643 DOI: 10.1097/gox.0000000000003144] [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: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lipoabdominoplasty has evolved over the last 6 decades through contributions from numerous luminaries in plastic and reconstructive surgery. METHODS The authors review historical perspective and provide a contemporary examination of trends in lipoabdominoplasty. RESULTS In 1967, Pitanguy popularized abdominoplasty (without liposuction) as a technique for augmenting ventral hernias repairs and subsequently for aesthetic improvement of the abdomen. After the introduction of suction assisted lipectomy by Illouz in 1983, abdominoplasty became a central tool in a diverse armamentarium of anterior and lateral abdominal wall contouring procedures. Liposuction was initially utilized with mini-abdominoplasty in order to improve contour. Subsequently, Matarasso advanced the safe combination of liposuction with full abdominoplasty. Additionally, he systematized the variety of cutaneous undermining, excision, and liposuction procedures utilized in abdominal contouring as indicated by the degree of skin laxity and musculofascial diastasis. Lockwood advocated high lateral tension closure of the superficial fascial system of the abdomen to improve the contour of the hips and flanks. Saldanha advanced selective undermining and anterior abdominal wall perforator preservation to minimize wound healing and seroma complications associated with lipoabdominoplasty procedures. CONCLUSION In abdominal contour surgery, surgeons can rely on classic techniques and algorithms that have withstood the test of time while modifying their approaches with advances backed by compelling and rigorously obtained evidence.
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Affiliation(s)
- Neil O’Kelly
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Khang Nguyen
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Alexander Gibstein
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - James P. Bradley
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Neil Tanna
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Alan Matarasso
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
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