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Neel OF, Algaidi Y, Alsubhi MN, Al-Terkawi RA, Salem A, Mortada H. Impact of Body-contouring Surgery Post Bariatric Surgery on Patient Well-being, Quality of Life, and Body Image: Saudi Arabia-based Cross-sectional Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5666. [PMID: 38504939 PMCID: PMC10950165 DOI: 10.1097/gox.0000000000005666] [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: 07/11/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024]
Abstract
Background Body-contouring surgery is commonly performed to address functional and aesthetic issues that can arise following bariatric surgery. However, there is limited understanding of the psychological impact of this procedure on Saudi Arabian patients who have undergone bariatric surgery. This study aimed to explore the effects of body-contouring surgery on the psychological well-being, quality of life, and body image of individuals who have undergone bariatric surgery. Methods This cross-sectional study assessed the psychological impact of body-contouring surgery by measuring levels of depression and generalized anxiety disorder using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. Results The study included a total of 227 participants, with 112 (49.3%) undergoing body-contouring surgery. Among the entire sample, 77.5% experienced excess skin folds following bariatric surgery. The prevalence of depression was 6% in the body-contouring group, lower than the 8% observed in the non-body-contouring group (P = 0.073). Notably, anxiety was significantly lower in the body-contouring group, with a prevalence of 4% compared with 6% in the non-body-contouring group (P = 0.006). Additionally, patients who had undergone body-contouring surgery reported higher scores for emotional well-being when compared with those who had not undergone body-contouring (P = 0.011). Conclusions The study suggests that body-contouring surgery improves the physical appearance of bariatric-surgery patients and reduces anxiety and depression, leading to improved psychological well-being. Further research, including larger and more diverse populations, such as multicenter studies at a regional or international level, is needed to validate these findings.
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Affiliation(s)
- Omar Fouda Neel
- From Division of Plastic Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
- Division of Plastic Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Yaser Algaidi
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abdelrahman Salem
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
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O'Connell G, Shih S, Shui M, Krikhely A, Bessler M, Rohde CH. The financial toxicity of postbariatric body contouring surgery: a survey study of an urban tertiary care center's patients. Surg Obes Relat Dis 2024:S1550-7289(24)00075-3. [PMID: 38519294 DOI: 10.1016/j.soard.2024.02.003] [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: 05/30/2023] [Revised: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Patients with obesity who undergo bariatric surgery achieve sustained weight loss but are often left with excess skin folds that cause functional and psychological deficits. To remove excess skin, patients can undergo postbariatric BCS; however, cost and lack of insurance coverage present a significant barrier for many patients. OBJECTIVES This study aimed to characterize the financial impact of treatment on all patients who received bariatric surgery and to compare between those receiving only bariatric surgery and those with postbariatric BCS. SETTING Email-based survey study at an urban tertiary care center. METHODS Surveys that included the COST-FACIT were sent to patients with a history of bariatric surgery and/or post-bariatric BCS. RESULTS One hundred and five respondents completed the survey, of which 19 reported having postbariatric BCS. Patients with postbariatric BCS had slightly higher COST scores than those receiving bariatric surgery only, but this difference was not significant (15.6 versus 17.8, P = .23). Most patients (76%) did not have an awareness of BCS or BCS cost prior to bariatric surgery, and many (68%) had more loose skin than anticipated. CONCLUSIONS Financial toxicity was similar across all postbariatric surgery patients surveyed regardless of history of BCS. However, survey respondents noted a gap between patient education and expectations around loose skin and body contouring that can be addressed through improved presurgical counseling.
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Affiliation(s)
- Gillian O'Connell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Sabrina Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Michelle Shui
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Abraham Krikhely
- Division of Bariatric Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Marc Bessler
- Division of Bariatric Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York.
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Alyahya T, Albesher MA, Alessa HA, Alali ZB, Al-Mulla AT. Barriers to Undergoing Body-Contouring Surgery Following Bariatric Surgery in Saudi Arabia. Cureus 2023; 15:e50558. [PMID: 38226119 PMCID: PMC10788699 DOI: 10.7759/cureus.50558] [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: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Introduction The prevalence of obesity has experienced a significant global increase in recent years, emerging as a prominent worry affecting numerous individuals throughout various countries, including Saudi Arabia. Bariatric surgery, a common treatment, often leads to excess skin. Despite its benefits, few patients choose body contouring surgery. A cross-sectional study aims to identify barriers, including socioeconomic and psychological factors. Methodology This is a cross-sectional study conducted in Saudi Arabia. Participants included those who underwent bariatric surgery. Data were collected through questionnaires and analyzed by Statistical Product and Service Solutions (SPSS, version 29) (IBM SPSS Statistics for Windows, Armonk, NY). Results Our study involved 662 Saudi participants with post-bariatric surgery, primarily females (386, 58.3%), aged 19-29 (44.3%). Most had undergone bariatric surgery (558, 84.3%), mainly gastric sleeve (485, 73.3%). Excess skin was a common issue (311, 47.0%). Difficulties included rashes and emotional distress (e.g., depression). About 8.3% had body-contouring surgery, including body lifts (13, 23.6%) and liposuction (19, 34.5%). Factors influencing surgery decisions included self-confidence (123, 18.6%) and cost (9.9%). Barriers for 32.2% considering surgery included cost (80.2%) and fear of a second surgery (45.6%). Females (67.1%), Saudis (85.4%), and employed individuals (49.3%) were more likely to consider surgery (p < 0.05). Conclusion Our study highlights the complexity of body-contouring decisions after bariatric surgery in Saudi Arabia. Cost and fear were barriers; females, Saudis, and employed individuals were more likely to consider surgery. A patient-centered approach, addressing barriers, and offering support are crucial for informed choices and improved well-being.
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Affiliation(s)
- Tareq Alyahya
- Plastic Surgery, King Faisal University, Al-Ahsa, SAU
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Rabah SM, Albrahim RA, Almajed EH, AlZabin AK, Aldawish RA, Alyahiwi LS, Alshabnan RA. Desire for Body Contouring Surgery after Bariatric Surgery: A Nationwide Cross-sectional Study in Saudi Arabia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5483. [PMID: 38098949 PMCID: PMC10721127 DOI: 10.1097/gox.0000000000005483] [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: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023]
Abstract
Background The obesity pandemic in Saudi Arabia has led to a high demand for bariatric surgery (BS). Post-BS patients experience rapid and massive weight loss, with most patients experiencing redundant skin, leading to a desire for body contouring surgery (BCS). Methods A cross-sectional study was conducted from September 2022 to May 2023 among patients who underwent BS in Saudi Arabia, using an online self-administered questionnaire. The questionnaire comprised sociodemographic data, weight, and BS-related questions, and the post-BS appearance questionnaire assessed the desire for BCS, excess skin satisfaction, and overall appearance. Results A total of 410 of the patients electively enrolled. The mean perceived satisfaction of post-BS patients with the body's excess skin was rated as 4.28 ± 1.69 out of 7 points. The overall desire for BCS among the post-BS population was equal to a collective mean desire of 2.10 ± 0.92 out of 4 points. The desired body sites for BCS were focused on the abdomen/waist, followed by the lower back, then upper arms, buttocks, and thighs. Only 25.1% of the patients fulfilled their desires and recently underwent BCS. Conclusions The study highlights the importance of incorporating plastic and reconstructive surgery as an integral part of the multidisciplinary approach to morbidly obese patients after BS and the need for national guidelines on the referral pathway for post-BS BCS.
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Affiliation(s)
- Sari M. Rabah
- From Plastic and Reconstructive Surgery Division, Department of Surgery, King Abdullah bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Razan A. Albrahim
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ebtesam H. Almajed
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Alya K. AlZabin
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reema A. Aldawish
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lara S. Alyahiwi
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rand A. Alshabnan
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Amarin MN, Atallah AA, Rashdan MZ, Atallah IA, Khrais MM, Jaber YH, Atallah AA, Ismail OM, Jaber KA, Fkheideh TK, Altaher RN. Body contouring after bariatric surgeries in Jordan: Awareness, prevalence, and challenges: A multicentric cross-sectional study. Medicine (Baltimore) 2023; 102:e34279. [PMID: 37603527 PMCID: PMC10443752 DOI: 10.1097/md.0000000000034279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023] Open
Abstract
Body-contouring surgeries are known to improve the quality of life and body image of patients undergoing bariatric surgery. However, only a small number of patients choose to undergo body-contouring surgeries. This study evaluated the prevalence of body-contouring surgeries among patients who underwent bariatric surgery in Jordan, and identified the limitations encountered. This study is an observational multicentric cross-sectional study. A validated questionnaire was distributed to patients who had undergone bariatric surgeries between July 2017 and June 2021 at the University of Jordan Hospital and a bariatric surgery private center in Amman, Jordan. Inclusion criteria were based on the type of bariatric surgery (Sleeve Gastrectomy or Roux-En-Y gastric bypass) and the surgery date falling within the study period, with participation requiring the completion of an online questionnaire. Collected data was analyzed using various statistical tests, with a predetermined alpha level of 0.05 to determine statistical significance. Of 451 eligible participants, a total of 305 patients completed the validated questionnaire. Of these, 11 responses were excluded due to incomplete data. The analysis focused on remaining 294 participants who underwent bariatric surgery between July 2017 and June 2021, with only 7 participants (2.4%) electing to undergo body-contouring surgeries. The primary barriers to body-contouring surgeries reported by participants were cost (62.7%) and fear of postoperative complications (31.8%). Females exhibited a significantly greater desire for body-contouring surgeries (P = .000), which was also related to the percentage of total weight loss following bariatric surgery (P = .025). However, no significant associations were observed between desiring body-contouring surgeries and marital status (P = .734) or employment status (P = .319). The low rate of body-contouring surgeries in Jordan reflects the importance of strengthening the patient-physician relationship through targeted education efforts that emphasize the expected consequences of bariatric surgery and the available solutions to address them. Additionally, encouraging collaboration among caregivers, healthcare authorities, and insurance providers is necessary to develop more inclusive treatment plans that are tailored to meet the diverse needs and socioeconomic backgrounds of patients.
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Affiliation(s)
- Marzouq N. Amarin
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Amani A. Atallah
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Z.A. Rashdan
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Izdiad A. Atallah
- Department of Educational Leadership and Foundations, School of Educational Sciences, The University of Jordan, Amman, Jordan
| | - Majdi M. Khrais
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yazan H. Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Omar M. Ismail
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Kamel A. Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Raed N. Altaher
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
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Alvarez AH, Valentine L, Stearns S, Foppiani J, Weidman AA, Lee BT, Lin SJ. A National Analysis of Socioeconomic Variables of Access to Inpatient Body Contouring Procedures After Bariatric Surgery. Obes Surg 2023; 33:2428-2433. [PMID: 37326906 DOI: 10.1007/s11695-023-06683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Weight loss following bariatric surgery often results in excess skin, which has led to a population of patients seeking body contouring surgery (BCS). This study aimed to investigate the prevalence of patients who underwent BCS following bariatric surgery using the national inpatient sample (NIS) database and to assess the demographic and socioeconomic variables of this cohort. METHODS NIS database was queried from 2016 to 2019 using ICD-10 codes to identify patients that underwent bariatric surgery procedures. Patients who subsequently underwent BCS were compared to those who did not. Multivariate logistic regression was used to identify factors associated with receipt of BCS. RESULTS A total of 263,481 patients that underwent bariatric surgery were identified. Of those, 1777 (0.76%) patients underwent subsequent inpatient BCS. Being female was associated with greater odds of undergoing body contouring (OR 1.28 95% CI 1.13-1.46, p = 0.0001). Patients who underwent BCS were more likely to have their procedure performed in large and government-controlled hospitals than bariatric surgery-only patients (55% vs. 50%, p < 0.0001, and 11% vs. 9.4%, respectively). Higher-income did not impose higher odds of receiving BCS compared to lowest income quartile (OR 0.99, 95% CI 0.86-1.16, p = 0.99066). Lastly, compared to Medicare holders, self-payers (OR 3.5, 95% CI 2.83-4.30, p < 0.0001) or private insurance (OR 1.23, 95% CI 1.09-1.40, p = 0.001) had greater odds of undergoing BCS. CONCLUSIONS There is a gap in access to BCS procedures, with cost and insurance coverage being the principal barriers. Developing policies that allow for holistic evaluation of patients is crucial to improve access to these procedures.
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Affiliation(s)
- Angelica Hernandez Alvarez
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA.
- Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA.
| | - Lauren Valentine
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Stephen Stearns
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Jose Foppiani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Allan A Weidman
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street Suite 5A, Boston, MA, 02215, USA
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Jordan K, Fawsitt CG, Carty PG, Clyne B, Teljeur C, Harrington P, Ryan M. Cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity: a systematic review of economic evaluations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:575-590. [PMID: 35869383 PMCID: PMC10175448 DOI: 10.1007/s10198-022-01494-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/21/2022] [Indexed: 05/12/2023]
Abstract
AIM To systematically identify and appraise the international literature on the cost-effectiveness of metabolic surgery for the treatment of comorbid type 2 diabetes (T2D) and obesity. METHODS A systematic search was conducted in electronic databases and grey literature sources up to 20 January 2021. Economic evaluations in a T2D population or a subpopulation with T2D were eligible for inclusion. Screening, data extraction, critical appraisal of methodological quality (Consensus Health Economic Criteria list) and assessment of transferability (International Society for Pharmacoeconomics and Outcomes Research questionnaire) were undertaken in duplicate. The incremental cost-effectiveness ratio (ICER) was the main outcome. Costs were reported in 2020 Irish Euro. Cost-effectiveness was interpreted using willingness-to-pay (WTP) thresholds of €20,000 and €45,000/quality-adjusted life year (QALY). Due to heterogeneity arising from various sources, a narrative synthesis was undertaken. RESULTS Thirty studies across seventeen jurisdictions met the inclusion criteria; 16 specifically in a T2D population and 14 in a subpopulation with T2D. Overall, metabolic surgery was found to be cost-effective or cost-saving. Where undertaken, the results were robust to sensitivity and scenario analyses. Of the 30 studies included, 15 were considered high quality. Identified limitations included limited long-term follow-up data and uncertainty regarding the utility associated with T2D remission. CONCLUSION Published high-quality studies suggest metabolic surgery is a cost-effective or cost-saving intervention. As the prevalence of obesity and obesity-related diseases increases worldwide, significant investment and careful consideration of the resource requirements needed for metabolic surgery programmes will be necessary to ensure that service provision is adequate to meet demand.
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Affiliation(s)
- Karen Jordan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- Health Information and Quality Authority, Dublin, Ireland.
| | | | - Paul G Carty
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
| | - Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Mairin Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin 8, Ireland
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Grift A, de Vries C, Monpellier V, Makarawung D, de Raaff C, Nijland L, Mink van der Molen A, Wiezer R, van Wagensveld B, van Veen R, de Castro S, Florisson J, Hoogbergen M. Using the BODY-Q to develop a prospective cohort of patients undergoing bariatric and body contouring surgery: A study protocol. Clin Obes 2023; 13:e12573. [PMID: 36470587 DOI: 10.1111/cob.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
The BODY-Q is a patient-reported outcome measure designed to measure health-related quality of life, satisfaction with appearance and experience with healthcare in patients with obesity who undergo bariatric surgery and/or body contouring surgery after massive weight loss. The aim of this study is to collect long term PRO-data from patients living with obesity undergoing bariatric surgery, comparing patient undergoing or not undergoing body contouring surgery. This study will be a multicentre, prospective longitudinal cohort study with participation of three bariatric medical centres in the Netherlands. The BODY-Q will be used to measure the satisfaction with appearance and HRQL. Patients undergoing bariatric surgery, age >18 years and <65 years and who are able to read and understand Dutch can be included. All bariatric procedures are eligible for inclusion. Administration of the questionnaires will be done preoperatively for bariatric and body contouring surgery as well as at 3, 12, 24, 36, 48 and 60 months post-operatively. Patient-reported outcomes measurements are becoming more important with the shift to patient-centred healthcare. The collected longitudinal data can be helpful in determining the effectiveness and value of bariatric and body contouring surgery from the patient's perspective, and can contribute to patient tailored postoperative care.
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Affiliation(s)
- Annewiek Grift
- Department of Plastic, Reconstructive and Hand Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Valerie Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, The Netherlands
| | - Dennis Makarawung
- Department of Plastic, Reconstructive and Hand Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Leontien Nijland
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Aebele Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Rene Wiezer
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Bart van Wagensveld
- Metabolic and Bariatric Department, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | | | | | - Joyce Florisson
- Department of Plastic, Reconstructive and Hand Surgery, OLVG, Amsterdam, The Netherlands
| | - Maarten Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Buer L, Kvalem IL, Bårdstu S, Mala T. Comparing Bariatric Surgery Patients Who Desire, Have Undergone, or Have No Desire for Body Contouring Surgery: a 5-Year Prospective Study of Body Image and Mental Health. Obes Surg 2022; 32:2952-2959. [PMID: 35739416 PMCID: PMC9392705 DOI: 10.1007/s11695-022-06117-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022]
Abstract
Purpose After bariatric surgery, body contouring surgery (BCS) is thought to improve body image, weight loss, and mental health. Many patients desire but do not undergo BCS after bariatric surgery. This patient subset has rarely been studied. The present study compares bariatric surgery patients that, at 5 years after surgery, desires, have undergone or have no desire for BCS regarding pre- and post-surgery body image and mental health, including within-group changes over time. Materials and Methods Data were collected from participants (N = 216) pre-bariatric surgery and at 1- and 5-year post-surgery. Health care providers measured body mass index (BMI). All other data were collected via self-report (questionnaires). Results At 5-year post-surgery, 30.6% had undergone BCS, 17.1% did not desire it, and 52.3% desired BCS. Patients who subsequently desired BCS scored lower on body satisfaction pre-surgery than the other groups. They also reported less resilience pre-surgery and more depressive symptoms at all times compared to participants with BCS. For five-year post-surgery, patients who desired BCS had lower body satisfaction levels than patients with BCS and were more bothered with excess skin relative to the two other groups. Body satisfaction improved in all three groups from baseline to five years and in most patients with BCS. Mental health improved only in patients with BCS. Conclusion This study emphasizes the relevance of identifying participants who desire but have not undergone BCS. The study suggests that BCS is associated with improved body image and mental health. Graphical abstract ![]()
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Affiliation(s)
- Liliana Buer
- Department of Psychology, University of Oslo, PB 1094, Blindern, N-0317, Oslo, Norway.
| | - Ingela Lundin Kvalem
- Department of Psychology, University of Oslo, PB 1094, Blindern, N-0317, Oslo, Norway
| | - Silje Bårdstu
- Norwegian Institute of Public Health, PB 222, 0213, Skøyen, Oslo, Norway
| | - Tom Mala
- Department of Gastrointestinal and Pediatric Surgery, and Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 4950 0424, Oslo, PB, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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A Prospective, Matched Comparison of Health-Related Quality of Life in Bariatric Patients following Truncal Body Contouring. Plast Reconstr Surg 2022; 149:1338-1347. [PMID: 35383722 DOI: 10.1097/prs.0000000000009098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Massive weight loss after bariatric surgery can lead to excess skin associated with functional and aesthetic sequelae. Access to the benefit provided by body contouring procedures may be limited by insurance approval, which does not consider health-related quality of life. The aim of this study was to quantify the benefit in health-related quality of life for patients who undergo body contouring procedures after massive weight loss. METHODS Patients evaluated for postbariatric body contouring procedures were systematically identified and prospectively surveyed using the BODY-Q. Health-related quality-of-life change for each functional scale was compared between those who underwent body contouring procedures (operative group, preoperatively versus postoperatively) and those who did not (nonoperative group, preoperatively versus resurvey) using t tests. Propensity score matching allowed the authors to balance baseline demographics, comorbidities, physical symptoms, and risk factors between cohorts. RESULTS Fifty-seven matched patients were analyzed (34 operative versus 23 nonoperative). No significant difference in age, body mass index, time between surveys, or preoperative BODY-Q scores existed between cohorts. The surgical group demonstrated a significant improvement in 10 out of 11 BODY-Q functional scales. The nonoperative group realized no improvements and, in the interim, had a significant deterioration in four BODY-Q scales. CONCLUSIONS Postbariatric body contouring procedures represent a critical and final step in the surgical weight loss journey for patients and are associated with significant improvements in health-related quality of life. Further deterioration in psychosocial and sexual health-related quality of life occurs in patients who do not undergo body contouring procedures following bariatric surgery. This study provides prospective comparative data that validate the field's standard intervention and justification for insurance approval. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Physical measurements and patients’ perception of excess skin on arms and thighs before and after bariatric surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background
Bariatric surgery is an effective weight loss method for patients with obesity. One side effect of bariatric surgery is uncomfortable excess skin. Much remains to be learned about physical measurements and patients’ subjective perceptions of it. Here, we investigated the pre- to post-bariatric changes in patients’ perception and physical measurements of the skin on the arms and thighs, in order to find possible subgroups especially affected by post-operative excess skin and to identify predicting factors.
Methods
One hundred forty-seven patients eligible for bariatric surgery completed the Sahlgrenska Excess Skin Questionnaire (SESQ) and underwent measurements of their skin before and 18 months after the procedure.
Results
Although most physical measurements decreased post-operatively, many patients reported increased discomfort. We identified one subgroup particularly prone to report excess skin on the arms post-operatively: women with high discomfort from excess skin on the arms and high body mass index (BMI), pre-operatively. Ptosis of the excess skin seems to be a feasible measurement for predicting post-operative discomfort. For every centimetre of ptosis pre-operatively, patients had 1.37- and 1.31-fold higher odds of achieving a score for post-operative discomfort from excess skin on the upper arms and thighs, respectively, of ≥ 6 (on a 0–10 scale).
Conclusions
We identified a subgroup especially affected by discomforting excess skin on arms and thighs after weight loss. Furthermore, we suggest a pre-operative pro-operative ptosis measuring to predict post-operative discomfort level. The result of this study further increases the knowledge of excess skin and should be useful in further improving patient education.
Level of Evidence: Level III, risk / prognostic study.
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12
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Ibrahiem SMS. Investigating the Safety of Multiple Body Contouring Procedures in Massive Weight Loss Patients. Aesthetic Plast Surg 2022; 46:2891-2902. [PMID: 35650300 PMCID: PMC9729125 DOI: 10.1007/s00266-022-02941-4] [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: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Deformities after massive weight loss are usually severe and affect many parts of the body, negatively impacting patients' social and intimate lives. A common request of patients after massive weight loss is to treat more than one anatomical area in one surgical procedure. Advantages include a single recovery period, lower surgical costs, and faster patient satisfaction. Disadvantages may include increased need for blood transfusions, longer hospital stay, and increased risk of common complications. OBJECTIVE The main objective of the study is to compare operative risk, hospital length of stay, complication rate, and patient satisfaction in MWLP according to the number of surgical procedures performed in the same surgical setting. PATIENTS AND METHODS This is a retrospective case-control study of 653 MWLP who underwent multiple contouring procedures simultaneously in a single surgical procedure. All patients underwent surgery between 2016 and 2020. The patients studied were divided into 4 groups according to the number of anatomical areas operated on. RESULTS A total of 1254 body contouring procedures were included in the study. Follow-up time ranged from 13 to 41 months, with a mean of 17 months. The mean age in the study was 33 years old. Women accounted for 78% of the studied population and men accounted for 22%. The overall complication rate (major and minor) was 105 cases (16.07%) in all groups CONCLUSION: Patient satisfaction was highest in patients who underwent 2-3 procedures within the same surgical setting compared to patients who underwent +3 procedures. Nevertheless, this is clinically insignificant. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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)
- Saad Mohamed Saad Ibrahiem
- grid.7155.60000 0001 2260 6941Department of Plastic Surgery, Reconstructive Surgery, and Burn Management, Faculty of Medicine, Alexandria University, Champollion Street, El-Khartoum Square, Azarita Medical Campus, Alexandria, 21111 Egypt
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13
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Mocquard C, Pluvy I, Chaput B, Hoogbergen MM, Watier E, Gandolfi S, Bertheuil N. Medial Thighplasty Improves Patient's Quality of Life After Massive Weight Loss: a Prospective Multicentric Study. Obes Surg 2021; 31:4985-4992. [PMID: 34378158 DOI: 10.1007/s11695-021-05654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of medial thighplasty following massive weight loss on the quality of life of patients and on their sexual life. METHODS We performed a multicentric, prospective study on the quality of life after massive weight loss using the Short-Form 36 questionnaire, the Female Sexual Function Index questionnaire, and the Moorehead-Ardelt Quality of life questionnaire. Forty-nine patients who underwent medial thighplasty were included in three centers and evaluation was made pre- and post-operatively. RESULTS The mean age of the patients was 44 ± 12.5 years. The average pre-medial thighplasty body mass index was 27 ± 3.8 kg/m2. All the categories of the SF36 questionnaire scored higher after surgery apart from "health change" but only the "role limitations due to emotional problems" category was significantly improved (p = 0.0081). Similarly, the Moorehead-Ardelt questionnaire showed a positive impact of the surgery on the quality of life in general (mean total score 1.04 ± 1.37) and on self-esteem, physical activity, social relationships, and work performance. Interestingly, sexual activity was not improved by the surgery and this result is in line with the FSFI, which showed no effect of medial thighplasty on sexual life. CONCLUSIONS Medial thighplasty improves the quality of life of patients after massive weight loss but does not seem to modify the sexual quality of life. These results clearly indicate that this surgery should be widely offered to patients seeking reconstruction of massive weight sequelae.
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Affiliation(s)
- Camille Mocquard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
- INSERM U1236, University of Rennes 1, 35000, Rennes, France.
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, 35000, Rennes, France.
| | - Isabelle Pluvy
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU of Besancon, 25000, Besançon, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU of Toulouse, 31000, Toulouse, France
| | - Maarten M Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Silvia Gandolfi
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU of Rouen, 76000, Rouen, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France
- INSERM U1236, University of Rennes 1, 35000, Rennes, France
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, 35000, Rennes, France
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Bennett BL, Grilo CM, Alperovich M, Ivezaj V. Body Image Concerns and Associated Impairment Among Adults Seeking Body Contouring Following Bariatric Surgery. Aesthet Surg J 2021; 42:275-282. [PMID: 34463702 PMCID: PMC8845003 DOI: 10.1093/asj/sjab327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The current study examined a range of body image concerns and associated distress and impairment in patients who have undergone bariatric surgery and are seeking subsequent body contouring surgery. OBJECTIVES The aim of this study was to investigate the hypotheses that individuals seeking body contouring endorse a broad pattern of body image concerns and that overall body image concern is associated with greater impairment and disability. METHODS The participants were 56 adults seeking body contouring surgery after bariatric surgery. All participants completed a self-report questionnaire designed for the present study to assess body image concerns specific to patients who have undergone bariatric surgery and a battery of established measures of disability, impairment, and eating-disorder psychopathology. RESULTS The most commonly endorsed concerns were related to loose skin (body dissatisfaction, feeling embarrassed in public, and skin rashes) whereas the least endorsed items included concerns related to scars from bariatric surgery (body dissatisfaction, avoidance of social situations, and difficulty concentrating). Participants endorsed a broad pattern of frequent distress and impairment related to physical body image changes post-bariatric surgery. Greater body image concerns were associated significantly with higher levels of disability, work-related impairment, and eating-disorder psychopathology. CONCLUSIONS Patients seeking body contouring surgery reported a range of body image concerns with significant associated distress, disability, and impairment related to physical changes post-bariatric surgery. The present findings underscore that although bariatric surgery is effective for reducing weight and metabolic disturbances, additional interventions for addressing body image concerns that are frequently distressing and impairing may be needed.
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Affiliation(s)
- Brooke L Bennett
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Alperovich
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Corresponding Author: Dr Valentina Ivezaj, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA. E-mail: ; Twitter: @bbennettphd
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15
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Elfanagely O, Othman S, Mellia JA, Messa CA, Fischer JP. Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring. Aesthetic Plast Surg 2021; 45:1105-1112. [PMID: 33196865 DOI: 10.1007/s00266-020-02046-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With a growing obesity epidemic, an increasing number of patients are seeking body contouring procedures (BCP). The aim of this study was to assess the association of morbid obesity (BMI > 40 kg/m2) with both clinical and health-related quality of life (H-RQOL) outcomes following BCP. METHODS Patients evaluated for post-bariatric BCP at a large academic hospital by one surgeon were retrospectively identified. Patients were surveyed using the BODY-Q© during initial and postoperative visits. Demographic, clinical, operative characteristics, and surgical outcomes data were extracted. BODY-Q domain scores were compared between morbidly obese (MO) and non-morbidly obese (NMO). The absolute change in HR-QOL scores for MO and NMO was also compared. RESULTS Overall, 59 patients were included (MO 72.9% vs. NMO 27.1%). The median age was 50 years old (Interquartile range [IQR] ± 17); the majority were non-Hispanic (89.8%), non-diabetic (81.4%), non-smokers (67.8%). Assessment of surgical site occurrences, reoperations, and the complication composite outcome revealed no statistical differences between groups (p >0.05). MO patients showed lower net improvement in three HR-QOL domains: satisfaction with body (median 30 [IQR ± 53] vs. 65 [IQR ± 54]; p = 0.036), body image (median 39 [IQR ± 55] vs. 52 [IQR ± 44]; p = 0.025), and social function (median 12 [IQR ± 18] vs. 19 [IQR ± 35]; p = 0.015). CONCLUSION Post-bariatric BCP can be safely performed in the MO patient without increased risk of complication. However, the benefit of truncal BCP is less in MO as it pertains to specific QOL domains: satisfaction with body, body image, and social function. 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)
- Omar Elfanagely
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - Sammy Othman
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - Joseph A Mellia
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - Charles A Messa
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States.
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16
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Jiang Z, Zhang G, Huang J, Shen C, Cai Z, Yin X, Yin Y, Zhang B. A systematic review of body contouring surgery in post-bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers. Obes Rev 2021; 22:e13201. [PMID: 33565201 DOI: 10.1111/obr.13201] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
Many post-bariatric patients have impaired health-related quality of life (HRQoL) due to excess skin following weight loss; however, it is inconclusive whether body contouring surgery (BCS) improves this impairment. We aimed to comprehensively summarize existing evidence of the effect of BCS on the HRQoL (primary outcome) and determine the prevalence of, the desire for, and barriers to BCS (secondary outcomes). Randomized controlled trials, cohort, cross-sectional, case-control, and longitudinal studies were systematically searched in PubMed, Embase, the Cochrane Central, and Web of Science. After screening 1923 potential records, 24 studies (representing 6867 participants) were deemed eligible. Only 18.5% of respondents from cross-sectional studies underwent BCS, with abdominal BCS as the most common procedure. Most participants desired BCS but listed "cost" and "lacking reimbursement" as the main barriers. Results suggest that most post-bariatric patients who underwent BCS experienced improvements in their HRQoL, which could be seen in almost every dimension evaluated, including body image and physical and psychosocial functions. Therefore, both bariatric and plastic surgeons should regard BCS not only as an aesthetic supplement but also as a vital part of functional recovery in the surgery-mediated weight loss journey and, thus, provide it to more post-bariatric patients.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guixiang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jinming Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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17
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de Vries CEE, Kalff MC, van Praag EM, Florisson JMG, Ritt MJPF, van Veen RN, de Castro SMM. The Influence of Body Contouring Surgery on Weight Control and Comorbidities in Patients After Bariatric Surgery. Obes Surg 2021; 30:924-930. [PMID: 31792701 PMCID: PMC7347702 DOI: 10.1007/s11695-019-04298-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction A considerable number of patients experience some long-term weight regain after bariatric surgery. Body contouring surgery (BCS) is thought to strengthen post-bariatric surgery patients in their weight control and maintenance of achieved improvements in comorbidities. Objectives To examine the impact of BCS on long-term weight control and comorbidities after bariatric surgery. Methods We performed a retrospective study in a prospective database. All patients who underwent primary Roux-en-Y gastric bypass (RYGB) and presented for preoperative consultation of BCS in the same hospital were included in the study. Linear and logistic mixed-effect model analyses were used to evaluate the longitudinal relationships between patients who were accepted or rejected for BCS and their weight loss outcomes or changes in comorbidities. Results Of the 1150 patients who underwent primary RYGB between January 2010 and December 2014, 258 patients (22.4%) presented for preoperative consultation of BCS. Of these patients, 126 patients eventually underwent BCS (48.8%). Patients who were accepted for BCS demonstrated significant better ∆body mass index (BMI) on average over time (− 1.31 kg/m2/year, 95% confidence interval (CI) −2.52 − −0.10, p = 0.034) and percent total weight loss (%TWL) was significantly different at 36 months (5.79, 95%CI 1.22 – 10.37, p = 0.013) and 48 months (6.78, 95%CI 0.93 – 12.63, p = 0.023) after body contouring consultation. Patients who were accepted or rejected did not differ significantly in the maintenance of achieved improvements in comorbidities. Conclusion BCS could not be associated with the maintenance of achieved improvements in comorbidities after bariatric surgery, whereas it could be associated with improved weight loss maintenance at 36 and 48 months after body contouring consultation. This association should be further explored in a large longitudinal study.
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Affiliation(s)
- C E E de Vries
- Department of Surgery, OLVG, Amsterdam, The Netherlands. .,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands.
| | - M C Kalff
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
| | - E M van Praag
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
| | - J M G Florisson
- Department of Plastic, Reconstructive and Hand Surgery, OLVG, Amsterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - R N van Veen
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
| | - S M M de Castro
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
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18
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Altieri MS. Comment on: Outcomes of patients older than 55 years undergoing abdominoplasty after bariatric surgery. Surg Obes Relat Dis 2021; 17:908-909. [PMID: 33757702 DOI: 10.1016/j.soard.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
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Atwood ME, Cassin SE, Rajaratnam T, Hawa R, Sockalingam S. The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale predicts binge eating, quality of life and weight regain following bariatric surgery. Clin Obes 2021; 11:e12421. [PMID: 33200534 DOI: 10.1111/cob.12421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
Presurgical psychosocial evaluations are an important component of bariatric care; yet, bariatric programs vary widely in their assessment and interpretation of psychosocial risk. There is a need for validated clinical tools that help to standardize and streamline the assessment of variables relevant to surgical outcomes. The present study contributes to the validation of the Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASS), a novel presurgical psychosocial evaluation tool, by: (a) examining the psychometric properties and optimal cutoff score, and; (b) examining the ability of the BIPASS tool to predict outcomes 1 and 2 years postsurgery, including weight regain, quality of life, psychiatric symptoms and adherence to postsurgical follow-up appointments. The BIPASS was applied retrospectively to the charts of 179 consecutively referred patients to a metropolitan bariatric surgery programme. Internal consistency for the BIPASS was acceptable, and interrater reliability was excellent. Higher BIPASS scores predicted higher binge eating symptomatology and lower mental health-related quality of life at 1 year postsurgery, and weight regain at 2 years (all P < .01). The BIPASS did not predict adherence to postsurgical follow-up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of disordered eating, poor quality of life and weight regain early in the postsurgical course, thereby facilitating patient education and appropriate interventions.
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Affiliation(s)
- Molly E Atwood
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Thiyake Rajaratnam
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Education, Centre for Addictions and Mental Health, Toronto, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Education, Centre for Addictions and Mental Health, Toronto, Ontario, Canada
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20
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Jiang Z, Zhang G, Du X, Chen Y, Shen C, Cai Z, Zhang B, Cheng Z. Experience of Excess Skin and Attitude to Body Contouring Surgery of a Chinese Post-Bariatric Population. Obes Facts 2021; 14:501-509. [PMID: 34365452 PMCID: PMC8546442 DOI: 10.1159/000517587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Western studies have explored post-bariatric patients concerning their views on excess skin and body contouring surgery (BCS), but Asian data were lacking. This study aims to investigate the experience of excess skin and attitude to BCS of a Chinese post-bariatric population. METHODS A total of 210 Chinese patients who underwent bariatric surgery from March 2015 to September 2018 were cross-sectional studied using the Sahlgrenska Excess Skin Questionnaire and a study-specific questionnaire. RESULTS The survey response rate was 61.4%. Most responders (78.2%) reported they had excess skin, and the most common sites were the abdomen (70.2%) and the upper arms (61.3%). Most responders (66.1%) reported being bothered by impaired health-related quality of life (HRQoL), and the most common problem was "the feeling of having unattractive body appearance" (42.7%). Many patients (37.9%) desired for BCS, and "the impact of excess skin is not serious enough" was the reason why not undergoing BCS being chosen most (28.1%), then "the cost is too high" (20.2%) and "worrying about the risk or complications of BCS" (18.4%). Younger age, female gender, higher weight loss, having full-time job, and earning higher income were independent factors increasing their desires for BCS. CONCLUSIONS Most Chinese post-bariatric patients have excess skin and are bothered by impaired HRQoL. The abdomen and upper arms are the sites where patients are most seriously affected and most eager for BCS. The conservative attitude toward BCS and the cost without reimbursement are the main barriers.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guixiang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Du
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, Ya'an People's Hospital, Ya'an, China
| | - Yi Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Cai
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Bo Zhang,
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- **Zhong Cheng,
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The PRS Rainbow Classification for Assessing Postbariatric Contour Deformities. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2874. [PMID: 32766041 PMCID: PMC7339310 DOI: 10.1097/gox.0000000000002874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: There is a need for a reliable classification system to grade contour deformities and to inform reimbursement of body contouring surgery after massive weight loss. We developed the PRS Rainbow Classification, which uses select photographs to provide standardized references for evaluating patient photographs, to classify contour deformities in postbariatric patients. To assess the reliability of the PRS Rainbow Classification to classify contour deformities in massive weight loss patients. Methods: Ten independent experienced plastic surgeons, 7 experienced medical advisors of the healthcare insurance company, and 10 laypersons evaluated 50 photographs per anatomical region (arms, breast, abdomen, and medial thighs). Each participant rated the patient photographs on a scale of 1–3 in an online survey. The inter-observer and the intra-observer reliabilities were determined using intra-class correlation coefficients (ICCs). The ICC analyses were performed for each anatomical region. Results: Inter-observer reliability was moderate to good in the body regions “arms,” “abdomen,” “medial thighs,” with mean ICC values of 0.678 [95% confidence interval (CI), 0.591–0.768], 0.685 (95% CI, 0.599–0.773), and 0.658 (95% CI, 0.569–0.751), respectively. Inter-observer reliability was comparable within the 3 different professional groups. Intra-observer reliability (test–retest reliability) was moderate to good, with a mean overall ICC value of 0.723 (95% CI, 0.572–0.874) for all groups and all 4 body regions. Conclusions: The moderate to good reliability found in this study validates the use of the PRS Rainbow Classification as a reproducible and reliable classification system to assess contour deformities after massive weight loss. It holds promise as a key part of instruments to classify body contour deformities and to assess reimbursement of body contouring surgery.
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22
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Impact of Lipo-Body Lift Compared to Classical Lower Body Lift on Postoperative Outcome and Patient's Satisfaction: A Retrospective Study. Aesthetic Plast Surg 2020; 44:464-472. [PMID: 31263934 DOI: 10.1007/s00266-019-01435-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Lately, the growing number of bariatric procedures performed each year led to an increasing demand for lower trunk reconstruction. Our team previously described the lipo-body lift (LBL) technique into lower duration of drainage and therefore seromas and other complications. In this study, we compared the classical body lift (CBL) technique to the LBL procedure. MATERIALS AND METHODS All patients who underwent a LBL or CBL after massive weight loss between November 2012 and October 2017 were included. Surgery outcome parameters were collected as well as patient satisfaction through a satisfaction score realized at least after 1 year postoperative. Comparisons between CBL and LBL were conducted to assess the surgery's safety and the patient's satisfaction. RESULTS A total of 130 patients were included, 61 patients who had a LBL were compared to 69 patients who had a CBL. The mean patient age was 39.64 ± 9.97 (21-66) years old, the mean body mass index before plastic surgery was 26.83 ± 3.08 kg/m2 (19.83-32.69), and the average weight loss was 53.40 ± 17.37 kg. The two groups had comparable preoperative data. Duration of drainage and hospital stay was significantly lower in the LBL group than in the CBL (p < 0.0001 and p < 0.0001, respectively). Surgical outcomes were comparable between groups as well as patient satisfaction scores. CONCLUSION Lipo-body lift allows early discharge of the patient by reducing the duration of drainage without increasing the risk for complications. In our opinion, this technique should be used for type 1 and 2 patients with no contraindication for abdominal liposuction. 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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Monpellier VM, de Vries CEE, Janssen IMC, van der Beek ESJ, Mink van der Molen AB, Hoogbergen MM, van der Lei B. The BAPRAS screening tool for reimbursement in a postbariatric population. J Plast Reconstr Aesthet Surg 2020; 73:1159-1165. [PMID: 32173244 DOI: 10.1016/j.bjps.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 11/29/2019] [Accepted: 02/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool. METHODS In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes. RESULTS Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m2 versus 30.4 kg/m2, p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales. CONCLUSIONS Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS.
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Affiliation(s)
- V M Monpellier
- Nederlandse Obesitas Kliniek, Huis ter Heide, the Netherlands; Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
| | - C E E de Vries
- Department of Surgery, OLVG West, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - I M C Janssen
- Nederlandse Obesitas Kliniek, Huis ter Heide, the Netherlands; Nederlandse Obesitas Kliniek West, Haaglanden Medical Centre, Den Haag, the Netherlands
| | - E S J van der Beek
- Department of Plastic Surgery, University Medical Centre of Groningen, the Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery, University Medical Centre of Utrecht, Utrecht, the Netherlands; Department of Plastic Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - M M Hoogbergen
- Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - B van der Lei
- Nederlandse Obesitas Kliniek, Huis ter Heide, the Netherlands; Department of Plastic Surgery, University Medical Centre of Groningen, the Netherlands; Bergman Clinics, Hilversum, the Netherlands
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The long-term effect of body contouring procedures on the quality of life in morbidly obese patients after bariatric surgery. PLoS One 2020; 15:e0229138. [PMID: 32084189 PMCID: PMC7034793 DOI: 10.1371/journal.pone.0229138] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction There has been a significant increase in the number of body contouring procedures performed worldwide. This study aimed to evaluate the long-term psychosocial effects of these procedures among patients who undergone weight loss surgery and maintained their body mass for a minimum of one year. Material and methods Post-bariatric patients undergoing body contouring procedures were recruited for the study consecutively. Inclusion criteria: BMI < 30 following bariatric surgery, weight maintenance for a minimum of 12 months, and completion of all follow up questionnaires (6 and 12 months). Patients were surveyed 24 hours before, 6-months, and 12-months post-procedure using a Polish validated version of BODY-Q. Results 30 consecutive patients with a mean age of 38 years (SD 5,91) were included in this study. The BODY-Q questionnaire revealed statistically significant improvements in the acceptance of body appearance after 12 months of follow up. In the abdominal area, the rise in scores achieved 90 from the starting level of 13, and the overall body image increased from 24 to 67. Moreover, in patients with postoperative complications (one hematoma and four minor wound dehiscence), the overall score did not differ from uncomplicated patients. Conclusions Body contouring procedures after massive weight loss significantly improve the general perception of personal appearance as well as both the psychological and social aspects of life in patients, already significantly stigmatized by their appearance. Body contouring procedures have essential value and should be widely offered as a step in the treatment of morbidly obese patients.
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A Cross-sectional Analysis of Insurance Coverage of Extremity Contouring After Massive Weight Loss. Ann Plast Surg 2020; 84:253-256. [DOI: 10.1097/sap.0000000000002150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H. Does Body Contouring After Bariatric Weight Loss Enhance Quality of Life? A Systematic Review of QOL Studies. Obes Surg 2019; 28:3333-3341. [PMID: 30069862 PMCID: PMC6153583 DOI: 10.1007/s11695-018-3323-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Massive weight loss following bariatric surgery can result in excess tissue, manifesting as large areas of redundant skin that can be managed by body contouring surgery. This study aims to quantify the effects of body contouring surgery on indicators of quality of life in post-bariatric patients. A systematic review and meta-analysis of the literature revealed on indices of quality of life in post-bariatric patients, before and after body contouring surgery. Body contouring surgery resulted in statistically significant improvements in physical functioning, psychological wellbeing and social functioning, as well as a reduction in BMI. Body contouring surgery offers a strategy to improve quality of life in patients suffering from the functional and psychosocial consequences of excess skin after bariatric surgery.
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Affiliation(s)
- Tania Toma
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Leanne Harling
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Thanos Athanasiou
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Ara Darzi
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK
| | - Hutan Ashrafian
- The Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, St Mary's Hospital Campus, Praed Street, W2 1NY, London, UK.
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Derderian SC, Patten L, Kaizer AM, Inge TH, Jenkins TM, Michalsky MP, Xie C, Dewberry LC, Sitzman TJ. Body contouring in adolescents after bariatric surgery. Surg Obes Relat Dis 2019; 16:137-142. [PMID: 31668945 DOI: 10.1016/j.soard.2019.09.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/23/2019] [Accepted: 09/11/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Bariatric surgery leads to sustained weight loss and resolution of obesity-associated co-morbidities in severely obese adolescents. However, one consequence of massive weight loss is excess skin and soft tissue. Many details regarding the timing, outcomes, and barriers associated with body contouring surgery (BCS) in youth who have undergone bariatric surgery are unknown. OBJECTIVES Describe the incidence and effect of BCS following bariatric surgery among adolescents. SETTING University Hospitals. METHODS Teen-Longitudinal Assessment of Bariatric Surgery is a prospective multi-institutional study of 242 adolescents who underwent bariatric surgery from 2007 to 2012. Utilization of BCS was analyzed in this population with comparison of anthropometrics and excess skin-related symptoms between those who did and those who did not undergo BCS. RESULTS Among the 198 study participants with BCS data available, 25 (12.6%) underwent 41 body contouring procedures after bariatric surgery. The most common BCS was panniculectomy (n = 23). Presence of pannus-related symptoms at baseline and the magnitude of weight loss within the first year after bariatric surgery were independently associated with subsequent panniculectomy (P = .04 and P = .03, respectively). All adolescents who underwent panniculectomy experienced resolution of pannus-related symptoms. At 5 years after bariatric surgery, 74% of those who did not undergo panniculectomy reported an interest in the procedure, and 58% indicated that cost/insurance coverage was the barrier to obtaining BCS. CONCLUSION Few adolescents who underwent bariatric surgery later underwent BCS procedures. Panniculectomy effectively treated pannus-related symptoms. Disparities in access to surgical care for adolescents who desire BCS warrants further investigation.
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Affiliation(s)
- S Christopher Derderian
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
| | - Luke Patten
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Alexander M Kaizer
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Thomas H Inge
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Todd M Jenkins
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Changchun Xie
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Lindel C Dewberry
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, Arizona
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Body Contouring Surgery after Massive Weight Loss: Excess Skin, Body Satisfaction, and Qualification for Reimbursement in a Dutch Post-Bariatric Surgery Population. Plast Reconstr Surg 2019; 143:1353-1360. [PMID: 30789477 DOI: 10.1097/prs.0000000000005525] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Body contouring surgery improves quality of life, weight loss, and body image after bariatric surgery. It is unclear why only a minority of the post-bariatric surgery population undergoes body contouring surgery. This study assesses overhanging skin, body satisfaction, and qualification for reimbursement of body contouring surgery in a Dutch post-bariatric surgery population. METHODS Post-bariatric patients were selected from a prospective database. Electronic questionnaires evaluated demographics, desire for body contouring surgery, excess skin, and satisfaction with their body. RESULTS A total of 590 patients were included: 368 patients (62.4 percent) desired body contouring surgery, 157 (26.6 percent) did not and 65 (11.0 percent) had undergone body contouring surgery. There were no significant differences between the groups regarding the percentage of patients who met the qualifications for reimbursement. Patients who desired body contouring surgery had more body parts affected by overhanging skin and more often rated the overhanging skin with a Pittsburgh Rating Scale grade 3 compared with patients without a desire to undergo body contouring surgery. The plastic surgeon was never consulted by 39.1 percent of the "desire" population; 44.1 percent of these patients met the weight criteria. CONCLUSIONS Post-bariatric patients who desired body contouring surgery had more excess skin than patients without a desire and were less satisfied with their body. Almost half of these patients never consulted a plastic surgeon, partly because of incorrect assumptions regarding reimbursement. Plastic surgeons (together with bariatric teams) should better inform these patients about body contouring surgery possibilities.
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the current status of research on psychosocial concerns following bariatric surgery. RECENT FINDINGS Bariatric surgery has a positive overall impact on weight and obesity-related comorbidities, as well as a positive short-term impact on mental health and psychosocial functioning. Nonetheless, research has documented a number of different psychosocial concerns that may emerge following surgery including maladaptive eating, substance use disorders, suicide, lack of social support, and excess skin. Moreover, special populations of patients may have distinctive psychosocial concerns based on sociodemographic factors such as age or severity of obesity. Available studies suggest that psychosocial interventions have a positive impact on post-surgery outcomes, particularly maladaptive eating. However, research is limited, and long-term data are lacking. Monitoring patients after bariatric surgery for negative psychosocial outcomes is warranted. Research is needed to develop and evaluate personalized approaches to optimize long-term weight loss and psychosocial adjustment.
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Affiliation(s)
- Melissa A Kalarchian
- School of Nursing, Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA.
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Malyar M, Peymani A, Johnson AR, Chen AD, Van Der Hulst RRWJ, Lin SJ. The Impact of Resident Postgraduate Year Involvement in Body-Contouring and Breast Reduction Procedures. Ann Plast Surg 2019; 82:310-315. [DOI: 10.1097/sap.0000000000001714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Royer E, Hersant B, Philandrianos C, Jaloux C, Casanova D, Bertrand B. Post-Bariatric Buttock Contouring With Gluteal Implants During Circumferential Body Lift: Step-By-Step Video Description and 1-Year Results. Aesthet Surg J 2019; 39:233-237. [PMID: 30395184 DOI: 10.1093/asj/sjy212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Barbara Hersant
- Department of Maxillofacial and Plastic, Reconstructive, and Aesthetic Surgery, at the Henri Mondor Hospital, Créteil, Assistance Publique - Hôpitaux de Paris, France
| | - Cécile Philandrianos
- Department of Plastic Surgery, at the La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Department of Plastic Surgery, at the La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Dominique Casanova
- Department of Plastic Surgery, at the La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Baptiste Bertrand
- Department of Plastic Surgery, at the La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Abstract
Body contouring after weight loss is becoming more prevalent. An appropriate systematic approach that starts from the first consultation needs to focus on residual comorbidities and weight of the patient. A thorough discussion about potential outcomes manages expectations. Preoperative optimization with smoking, herbal cessation, and nutritional assessment is mandatory. Planned staged approach minimizes lengthy procedures associated with increased postoperative morbidity. In the operating room, appropriate ambient temperature, positioning of the patient, and continuous discussion between surgeon and anesthesiologist prevent further complications. Careful transition to postoperative care with early ambulation and use of compressive garments add to an approach to minimize postoperative complications.
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Affiliation(s)
- George Kokosis
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 601 North Caroline street, Baltimore, MD 21287, USA
| | - Devin Coon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 601 North Caroline street, Baltimore, MD 21287, USA.
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Patient-Reported Satisfaction Following Post-bariatric Surgery: A Systematic Review. Aesthetic Plast Surg 2018; 42:1320-1330. [PMID: 29948099 DOI: 10.1007/s00266-018-1146-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The aims of our study were to identify studies that evaluated patient satisfaction following post-bariatric surgery, analyse existing questionnaires, and summarise their development, psychometric properties, and content. PATIENTS AND METHODS A multistep search was undertaken on the web-based PubMed database from the National Library of Medicine to identify studies on patient satisfaction and quality of life following post-bariatric surgery. The authors summarised all the questionnaires used in every study and categorised them as generic, surgery specific, or ad hoc, and whether they contained either validated or unvalidated measures. RESULTS Our search generated a total of 1754 articles. We performed a systematic review of the 12 remaining studies, because these had sufficient data and met the inclusion criteria. All the studies identified from the literature review were assessed to determine the type of surgery used, and whether or not the questionnaire used to analyse patient satisfaction had been validated. The questionnaires were analysed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 20 individual questionnaires that included 10 generic instruments that assessed quality of life, six instruments specific for post-bariatric surgery, three instruments specific for breast surgery. CONCLUSIONS In post-bariatric patients, the BODY-Q was shown to be a more objective and confident measure for evaluating the quality of life of patients following post-bariatric surgery. LEVEL OF EVIDENCE III 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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Ingargiola MJ, Molina Burbano F, Yao A, Motakef S, Sanati-Mehrizy P, Burish NM, David LR, Taub PJ. Plastic Surgery Resident-Run Cosmetic Clinics: A Survey of Current Practices. Aesthet Surg J 2018; 38:793-799. [PMID: 29548007 DOI: 10.1093/asj/sjy065] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The recently increased minimum aesthetic surgery requirements set by the Plastic Surgery Residency Review Committee of the Accreditation Council for Graduate Medical Education highlight the importance of aesthetic surgery training for plastic surgery residents. Participation in resident aesthetic surgery clinics has become an important tool to achieve this goal. Yet, there is little literature on the current structure of these clinics. OBJECTIVES The authors sought to evaluate current practices of aesthetic resident-run clinics in the United States. METHODS A survey examining specific aspects of chief resident clinics was distributed to 70 plastic surgery resident program directors in the United States. Thirty-five questions sought to delineate clinic structure, procedures and services offered, financial cost to the patient, and satisfaction and educational benefit derived from the experience. RESULTS Fifty-two questionnaires were returned, representing 74.2% of programs surveyed. Thirty-two (63%) reported having a dedicated resident aesthetic surgery clinic at their institution. The most common procedures performed were abdominoplasty (n = 20), breast augmentation (n = 19), and liposuction (n = 16). Most clinics offered neuromodulators (n = 29) and injectable fillers (n = 29). The most common billing method used was a 50% discount on surgeon fee, with the patient being responsible for the entirety of hospital and anesthesia fees. Twenty-six respondents reported feeling satisfied or very satisfied with their resident aesthetic clinic. CONCLUSIONS The authors found aesthetic chief resident clinics to differ greatly in their structure. Yet the variety of procedures and services offered makes participation in these clinics an effective training method for the development of both aesthetic surgical technique and resident autonomy.
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Affiliation(s)
- Michael J Ingargiola
- Division of Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
| | | | - Amy Yao
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Saba Motakef
- Department of Plastic Surgery, Loma Linda University, Loma Linda, CA
| | | | - Nikki M Burish
- Division of Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
| | | | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
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Monpellier VM, Antoniou EE, Mulkens S, Janssen IMC, van der Molen ABM, Jansen ATM. Body image dissatisfaction and depression in postbariatric patients is associated with less weight loss and a desire for body contouring surgery. Surg Obes Relat Dis 2018; 14:1507-1515. [PMID: 30131312 DOI: 10.1016/j.soard.2018.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results. OBJECTIVES To evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS. SETTING Outpatient clinic. METHODS One thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model. RESULTS There was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n = 157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction. CONCLUSIONS There are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients.
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Affiliation(s)
- Valerie M Monpellier
- Nederlandse Obesitas Kliniek, Huis ter Heide, Utrecht, the Netherlands; Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Evangelia E Antoniou
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Sandra Mulkens
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek, Huis ter Heide, Utrecht, the Netherlands; Department of Surgery, Nederlandse Obesitas Kliniek West, The Hague, The Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive Surgery and Hand surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Plastic, Reconstructive Surgery and Hand surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Anita T M Jansen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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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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Abstract
The ideal patient for purse-string gluteoplasty has buttock deflation and ptosis, and wishes to improve projection. Key elements of the procedure are buttock lifting combined with auto-augmentation, no undermining of auto-augmentation tissue, and use of a purse-string suture to enhance projection of auto-augmentation tissue. Purse-string gluteoplasty is a safe and effective technique to correct buttock ptosis and atrophy.
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Affiliation(s)
- Joseph P Hunstad
- Department of Plastic Surgery, Hunstad Kortesis Bharti Plastic Surgery & MedSpa, 11208 Statesville Road, Suite #300, Huntersville, NC 28078, USA
| | - Mark A Daniels
- Department of Plastic Surgery, Hunstad Kortesis Bharti Plastic Surgery & MedSpa, 11208 Statesville Road, Suite #300, Huntersville, NC 28078, USA
| | - John C Crantford
- Department of Plastic Surgery, Hunstad Kortesis Bharti Plastic Surgery & MedSpa, 11208 Statesville Road, Suite #300, Huntersville, NC 28078, USA.
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Levan P, Bassilios Habre S. Gluteal Implants Versus Autologous Flaps in Patients with Postbariatric Surgery Weight Loss: A Prospective Comparative Study of 3-Dimensional Gluteal Projection After Lower Body Lift. Aesthet Surg J 2017; 37:1012-1021. [PMID: 28398515 DOI: 10.1093/asj/sjx033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deformities and excess skin resulting from massive weight loss are corrected with circumferential lower body lift (LBL). The gluteal area is frequently flattened due to aggressive skin excision during LBL. Gluteal implants can circumvent this problem. OBJECTIVES We aimed to objectively evaluate the outcomes of gluteal augmentation with implants versus flap surgery performed simultaneously with LBL. METHODS Between January 2014 and June 2015, twenty-seven patients underwent LBL with gluteal implants (10 patients), flaps (14 patients), or no gluteal augmentation (3 patients) in our hospital. Three-dimensional analysis was used to assess gluteal projection preoperatively and at 6 months. Gain in projection, pain scores, complications, and patient and surgeon satisfaction were compared. RESULTS The mean follow-up duration was 18 months. The mean gain in projection at 6 months was 4.9 mm in the implant group, -0.5 mm in the flap group (P = 0.1), and -9.6 mm in the control group. The mean implant volume was 294.5 mL. Operation time was shorter in the flap group (192 min) than in the implant group (218 min, P = 0.001). Surgeon satisfaction was higher in the implant group (P = 0.007). Implants were more painful than flaps at 4 days and 2 weeks (P = 0.004 for both). There were 6 minor complications (60%) in the implant group versus 7 (50%) in the flap group (P = 0.94). CONCLUSIONS In selected patients, LBL with gluteal implants is safe and slightly increases gluteal projection. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Philippe Levan
- From the Department of Plastic and Reconstructive Surgery, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Samer Bassilios Habre
- From the Department of Plastic and Reconstructive Surgery, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Liu RH, Irwin JD. Understanding the post-surgical bariatric experiences of patients two or more years after surgery. Qual Life Res 2017; 26:3157-3168. [PMID: 28707046 DOI: 10.1007/s11136-017-1652-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND In Canada, one year after bariatric surgery follow-up appointments become less frequent and surgical recipients must cope with weight management more independently. Up to 50% of patients experience weight regain by two years post-surgery. Understanding the lived experiences of those who have gone through the bariatric process may shed light on what is needed to support others moving forward. Therefore, the purpose of the study was to gain an understanding of the physical, psychological, social, and clinic-related experiences of individuals who have undergone bariatric surgery at least two years prior. PURPOSE The purpose of the study was to gain an understanding of the physical, psychological, social, and clinic-related experiences of individuals who have undergone bariatric surgery at least two years prior. METHODS In-depth, individual semi-structured interviews lasting approximately 60 min were conducted. Interviews were transcribed verbatim and inductive content analysis was used to identify emerging themes. Methods were employed throughout to support data trustworthiness. RESULTS Participants (n = 28; 21 female) were primarily middle-aged (mean: 49.7 ± 12.7 years old), Caucasian (71%), and completed bariatric surgery more than three years. The data fell naturally into four primary themes, namely physical changes and challenges, psychological experiences, social functioning and support, and clinic-related experiences and reflections. CONCLUSIONS Generally, participants described positive improvements in their physical, psychological, and social state since surgery. However, concerns pertaining to several unanticipated outcomes of the surgery were underscored and informed the recommendations for other patients to be prepared to relearn about ones' body, utilize the support services available, and be aware that social relationships may change and/or require tending. Participants' insights can be used to help others meet with long-term success post-bariatric surgery.
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Affiliation(s)
- Rebecca H Liu
- Department of Health & Rehabilitation Sciences, Western University, London, ON, Canada.,Faculty of Health Sciences, Health Promotion Research Laboratory, Western University, London, ON, Canada
| | - Jennifer D Irwin
- Department of Health & Rehabilitation Sciences, Western University, London, ON, Canada. .,Faculty of Health Sciences, Health Promotion Research Laboratory, Western University, London, ON, Canada. .,Faculty of Health Sciences, School of Health Studies, Western University, Room 338, Arthur and Sonia Labatt Health Sciences Building, London, ON, N6A 5B9, Canada.
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Wiser I, Heller L, Spector C, Fliss E, Friedman T. Body contouring procedures in three or more anatomical areas are associated with long-term body mass index decrease in massive weight loss patients: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2017; 70:1181-1185. [PMID: 28676320 DOI: 10.1016/j.bjps.2017.05.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Massive weight loss (MWL) patients who undergo body contouring plastic surgery (BCPS) display superior long-term weight maintenance. The effect of the number of anatomical areas contoured on weight dynamics is undetermined. OBJECTIVES To determine whether body mass index (BMI) dynamics following BCPS are associated with the number of anatomical areas operated. METHODS A retrospective cohort study was conducted. Study groups were defined by the number of anatomical areas operated (1, 2, and 3+). BMI velocity was defined as a ratio between BMI change following BCPS and follow-up time. Multinomial logistic regression was performed to assess the independent association with BMI velocity. RESULTS A total of 222 patients undergoing 513 BCPSs between 2009 and 2014 were included in the study (mean age 36.8 ± 10.9 years, 77% females). Group 3+ (n = 88) had a negative mean BMI velocity compared with positive values in Groups 1 and 2 (-0.11 ± 1.0 vs. 0.44 ± 1.4 and 0.03 ± 1.2, respectively; p = 0.03). Independent risk factors for positive BMI velocity (>0.5 kg/m2/year) included single anatomical area BCPS compared to three or more (OR = 3.37; CI 95% 1.24-9.14; p = 0.017) and psychiatric medication use (OR = 6.73; CI 95% 1.15-39.35; p = 0.034). Independent protective factors included diabetes mellitus (OR = 0.094; CI 95% 0.01-0.99; p = 0.049). CONCLUSIONS BCPS in three or more anatomical areas following MWL is associated with a long-term weight loss following BCPS. As part of the health strategy to maintain normal BMI values and achieve overall quality of life improvement in MWL patients, clinicians and health policy makers should positively consider recommending BCPS in multiple anatomical areas.
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Affiliation(s)
- Itay Wiser
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Coral Spector
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Fliss
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Friedman
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Altieri MS, Yang J, Park J, Novikov D, Kang L, Spaniolas K, Bates A, Talamini M, Pryor A. Utilization of Body Contouring Procedures Following Weight Loss Surgery: A Study of 37,806 Patients. Obes Surg 2017; 27:2981-2987. [DOI: 10.1007/s11695-017-2732-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patient satisfaction, body image, and quality of life after lower body lift: a prospective pre- and postoperative long-term survey. Surg Obes Relat Dis 2017; 13:882-887. [DOI: 10.1016/j.soard.2017.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/17/2016] [Accepted: 01/04/2017] [Indexed: 12/16/2022]
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Abstract
INTRODUCTION Bariatric surgery has emerged as an effective method of combating the morbid obesity epidemic. However, the massive weight loss that follows may result in contour changes that can affect body image and quality of life. Our study examines the effects and consequences of bariatric surgery and subsequent body contouring on body image and quality of life. METHODS Patients were prospectively followed up through their experience with bariatric surgery and subsequent body contouring surgery. Using 2 validated survey instruments, the Multidimensional Body-Self Relations Questionnaire and the Short Form 36 (SF-36), patients completed questionnaires preoperatively and at 6, 12, and 24 months postoperatively. Mean scores were determined by repeated measures analyses of variance F tests. RESULTS One hundred seventy-five patients were surveyed before bariatric surgery, with noted declines in survey completion at 6, 12, and 24 months. Appearance Evaluation scores improved significantly at all intervals (P = 0.0033), as did Body Area Satisfaction Scale and Appearance Orientation scores (P = 0.0079 and P = 0.044, respectively). While Overweight Preoccupation and Self-Classified Weight scores decreased over time, only the latter was significant (P < 0.0001). The composite SF-36 score for patients awaiting bariatric surgery (54.1%) with postoperative scores at 6 (67.6%,), 12 (at 74.0%), and 24 (76.7%) months being significantly higher (P < 0.0001). The body contouring group consisted of 41 patients who primarily had lower body procedures, with 31 patients surveyed at 6 months and 27 patients at 12 months. For this cohort, Appearance Evaluation and Body Area Satisfaction Scale scores both improved significantly (P = 0.0001 and P = 0.0005, respectively) whereas Appearance Orientation scores declined significantly (P = 0.0055). Both Overweight Preoccupation and Self-Classified Weight scores decreased with only the latter being statistically significant (P = 0.0286). Postoperative SF-36 scores at 6 (72.9%) and 12 (64.5%) months were no different than patients awaiting body contouring (71.3%). CONCLUSIONS Using 2 validated survey instruments, we show that patients undergoing bariatric surgery have improvements in body image and quality of life. Subsequent postbariatric body contouring surgery results in further improvements in body image. Our findings provide measurable evidence for the value of body contouring after significant weight loss, which may favor greater insurance coverage for this patient population.
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Qureshi AA, Parikh RP, Myckatyn TM, Tenenbaum MM. Resident Cosmetic Clinic: Practice Patterns, Safety, and Outcomes at an Academic Plastic Surgery Institution. Aesthet Surg J 2016; 36:NP273-80. [PMID: 27222107 DOI: 10.1093/asj/sjw080] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Comprehensive aesthetic surgery education is an integral part of plastic surgery residency training. Recently, the ACGME increased minimum requirements for aesthetic procedures in residency. To expand aesthetic education and prepare residents for independent practice, our institution has supported a resident cosmetic clinic for over 25 years. OBJECTIVES To evaluate the safety of procedures performed through a resident clinic by comparing outcomes to benchmarked national aesthetic surgery outcomes and to provide a model for resident clinics in academic plastic surgery institutions. METHODS We identified a consecutive cohort of patients who underwent procedures through our resident cosmetic clinic between 2010 and 2015. Major complications, as defined by CosmetAssure database, were recorded and compared to published aesthetic surgery complication rates from the CosmetAssure database for outcomes benchmarking. Fisher's exact test was used to compare sample proportions. RESULTS Two hundred and seventy-one new patients were evaluated and 112 patients (41.3%) booked surgery for 175 different aesthetic procedures. There were 55 breast, 19 head and neck, and 101 trunk or extremity aesthetic procedures performed. The median number of preoperative and postoperative visits was 2 and 4 respectively with a mean follow-up time of 35 weeks. There were 3 major complications (2 hematomas and 1 infection requiring IV antibiotics) with an overall complication rate of 1.7% compared to 2.0% for patients in the CosmetAssure database (P = .45). CONCLUSIONS Surgical outcomes for procedures performed through a resident cosmetic clinic are comparable to national outcomes for aesthetic surgery procedures, suggesting this experience can enhance comprehensive aesthetic surgery education without compromising patient safety or quality of care. LEVEL OF EVIDENCE 4 Risk.
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Affiliation(s)
- Ali A Qureshi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Rajiv P Parikh
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Terence M Myckatyn
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Marissa M Tenenbaum
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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The BODY-Q: A Patient-Reported Outcome Instrument for Weight Loss and Body Contouring Treatments. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e679. [PMID: 27200241 PMCID: PMC4859238 DOI: 10.1097/gox.0000000000000665] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/16/2016] [Indexed: 01/28/2023]
Abstract
Background: Body contouring performed for cosmetic purposes, or after weight loss, has the potential to improve body image and health-related quality of life (HRQL). The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring. In this article, we describe the psychometric properties of the BODY-Q scales after an international field-test. Methods: Weight loss and body contouring patients from Canada, United States, and United Kingdom were recruited between November 2013 and February 2015. Data were collected using an iPad directly into a web-based application or a questionnaire booklet. Rasch measurement theory analysis was used for item reduction and to examine reliability, validity, and ability to detect change. Results: The sample included 403 weight loss and 331 body contouring patients. Most BODY-Q items had ordered thresholds (134/138) and good item fit. Scale reliability was acceptable, ie, Person separation index >0.70 for 16 scales, Cronbach α ≥0.90 for 18 of 18 scales, and Test–retest ≥0.87 for 17 of 18 scales. Appearance and HRQL scores were lower in participants with more obesity-related symptoms, higher body mass index, and more excess skin and in those pre- versus postoperative body contouring. The 134 weight loss patients who completed the BODY-Q twice, either 6 weeks (weight loss/nonsurgical body contouring program) or 6 months (bariatric program) later, improved significantly on 7 appearance and 4 HRQL scales. Conclusion: The BODY-Q is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes in patients who undergo weight loss and/or body contouring.
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Danilla S, Cuevas P, Aedo S, Dominguez C, Jara R, Calderón ME, Al-Himdani S, Rios MA, Taladriz C, Rodriguez D, Gonzalez R, Lazo Á, Erazo C, Benitez S, Andrades P, Sepúlveda S. Introducing the Body-QoL®: A New Patient-Reported Outcome Instrument for Measuring Body Satisfaction-Related Quality of Life in Aesthetic and Post-bariatric Body Contouring Patients. Aesthetic Plast Surg 2016; 40:19-29. [PMID: 26578194 DOI: 10.1007/s00266-015-0586-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop a new patient-reported outcome instrument (PRO) to measure body-related satisfaction quality of life (QoL). METHODS Standard 3-phase PRO design was followed; in the first phase, a qualitative design was used in 45 patients to develop a conceptual framework and to create preliminary scale domains and items. In phase 2, large-scale population testing on 1340 subjects was performed to reduce items and domains. In phase 3, final testing of the developed instrument on 34 patients was performed. Statistics used include Factor, RASCH, and multivariate regression analysis. Psychometric properties measured were internal reliability, item-rest, item-test, and test-retest correlations. RESULTS The PRO-developed instrument is composed of four domains (satisfaction with the abdomen, sex life, self-esteem and social life, and physical symptoms) and 20 items in total. The score can range from 20 (worst) to 100 (best). Responsiveness was 100 %, internal reliability 93.3 %, and test-retest concordance 97.7 %. Body image-related QoL was superior in men than women (p < 0.001) and decreased with increasing age (p = 0.004) and BMI (p < 0.001). Post-bariatric body contouring patients score lower than cosmetic patients in all domains of the Body-QoL instrument (p < 0.001). After surgery, the score improves by on average 21.9 ± 16.9 (effect size 1.8, p < 0.001). CONCLUSIONS Body satisfaction-related QoL can be measured reliably with the Body-QoL instrument. It can be used to quantify the improvement in cosmetic and post-bariatric patients including non- or minimally invasive procedures, suction assisted lipectomy, abdominoplasty, lipoabdominoplasty, and lower body lift and to give an evidence-based approach to standard practice. LEVEL OF EVIDENCE I 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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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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Zhang Y, Xu H, Wang T, He J, Qiao Y, Wei J, Dong J. Psychosocial Predictors and Outcomes of Delayed Breast Reconstruction in Mastectomized Women in Mainland China: An Observational Study. PLoS One 2015; 10:e0144410. [PMID: 26641252 PMCID: PMC4671805 DOI: 10.1371/journal.pone.0144410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 11/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background The aim of the present study was to evaluate potential psychosocial factors that impact Chinese female breast cancer patients to select breast reconstruction (BR), and potential connection of psychosocial outcomes with their satisfaction with BR. Methods A total of 264 female breast cancer patients with mastectomy were recruited from 2012 to 2014. All patients were informed with BR options at their first visit. Personal and medical profiles were collected. Body image, self-esteem, depression and anxiety were assessed using validated scales. Patients who were selected to undergo BR after the first visit were followed up for six months. The same assessment was performed at 6 months post BR, and their satisfaction with BR was evaluated using the Alderman scale. Multivariate linear and logistic regressions were performed. Results Forty-seven percent of the patients (126/264) opted to undergo BR within six months after the initial visit. Multivariate logistic regression analysis revealed that self-esteem (P < 0.05), body image (P < 0.01), education level (P < 0.05), and their husband’s recommendation (P < 0.05) were highly related to the patients’ decision to undergo BR. In addition, multivariate linear regression analysis showed that patient satisfaction with BR was significantly associated with preoperative body image (P < 0.01), postoperative improvement in self-esteem (P < 0.01), improvement in body image (P < 0.01), reduction in depression (P < 0.05), pain (P < 0.05), and scarring (P < 0.01). Conclusions The psychosocial factors including self-esteem and body image are highly related to selecting the BR option and post-BR satisfaction in Chinese female breast cancer patients.
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Affiliation(s)
- Yi Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinguang He
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufei Qiao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiao Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiasheng Dong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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Pappachan JM, Viswanath AK. Metabolic surgery: A paradigm shift in type 2 diabetes management. World J Diabetes 2015; 6:990-998. [PMID: 26240695 PMCID: PMC4515448 DOI: 10.4239/wjd.v6.i8.990] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 04/30/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are major public health issues globally over the past few decades. Despite dietary interventions, lifestyle modifications and the availability of several pharmaceutical agents, management of T2DM with obesity is a major challenge to clinicians. Metabolic surgery is emerging as a promising treatment option for the management of T2DM in the obese population in recent years. Several observational studies and a few randomised controlled trials have shown clear benefits of various bariatric procedures in obese individuals in terms of improvement or remission of T2DM and multiple other health benefits such as improvement of hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainties about the long-term implications of metabolic surgery such as relapse of T2DM after initial remission, nutritional and psychosocial complications and the optimal body mass index for different ethnic groups exist. The article discusses the major paradigm shift in recent years in the management of T2DM after the introduction of metabolic surgery.
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