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Gelidan AG, Al Qurashi AA, Dahlawi M, Hafiz BF, Halawani IR, Mandora RM, Tariq S, Hennawi YB, Bukhari RI, Alobaidi HA. A Systematic Review of Questionnaires Assessing Patient Satisfaction in Plastic Surgery: Tools, Topics, and Surgical Types. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6156. [PMID: 39281089 PMCID: PMC11398821 DOI: 10.1097/gox.0000000000006156] [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: 05/27/2023] [Accepted: 07/24/2024] [Indexed: 09/18/2024]
Abstract
Background Patient satisfaction is crucial for evaluating healthcare services, including plastic surgery. This systematic review aims to analyze questionnaires assessing patient satisfaction in plastic surgery, identifying their strengths and weaknesses to improve outcomes and enhance the quality of care. Methods A comprehensive literature search was conducted using electronic databases. Studies were included if they were original research articles, written in English, and focused on patient satisfaction questionnaires in plastic surgery. Data extraction and descriptive statistics were used to summarize the data. Results A total of 105 studies were included. General/overall satisfaction was the most common topic addressed (99.04%). Cosmetic outcomes were the most frequently assessed category (34.3%). Breast reconstruction was the most common procedure (33.3%). Most studies used a combination of generic and procedure-specific questionnaires (45.71%). The most frequently used measurement tools were BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61%. Conclusions This review provides a comprehensive analysis of patient satisfaction questionnaires in plastic surgery, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving plastic surgery outcomes and enhancing the quality of care. Future research should refine assessment tools to address patients' needs and promote patient-centered outcomes in plastic surgery.
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Affiliation(s)
- Adnan G Gelidan
- From the Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences at the National Guards, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Maryam Dahlawi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Bayan F Hafiz
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - Roaa M Mandora
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Shahad Tariq
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Yasser B Hennawi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Rahaf I Bukhari
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Hussain Amin Alobaidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences at the National Guards, Jeddah, Saudi Arabia
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Jiretorn L, Engström M, Laursen C, Ramos Salas X, Järvholm K. 'My goal was to become normal'-A qualitative investigation of coping with stigma, body image and self-esteem long-term after bariatric surgery. Clin Obes 2024; 14:e12657. [PMID: 38549516 DOI: 10.1111/cob.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024]
Abstract
Improved self-esteem and body image, as well as reduced experiences of weight stigma are important patient-reported obesity treatment outcomes. However, more knowledge is needed about how individuals who have undergone metabolic and bariatric surgery (MBS) perceive themselves and their bodies and use different coping strategies in relation to body image and self-esteem long-term after MBS. In this qualitative study body image, self-esteem, weight stigma and coping strategies were explored among 18 individuals who underwent MBS more than 10 years ago when interviewed. Using reflexive thematic analysis, two primary themes were identified: 'Experiences of living with a stigmatised body' and 'Coping with weight stigma, body image and self-esteem', and eight sub-themes. Findings capture frequent experiences of weight stigma before bariatric surgery, the need for coping with stigma and body dissatisfaction before and after MBS, and how different coping strategies are related to participants' perceptions of their bodies and self-concepts. More adaptive coping strategies, such as confrontation and cognitive restructuring may facilitate more positive body image outcomes, than more ruminative and avoidant strategies. Understanding adaptive coping strategies can be useful to develop interventions to reduce negative consequences of weight stigma on body image and self-esteem.
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Affiliation(s)
- Linda Jiretorn
- Department of Psychology, Lund University, Lund, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Glenney AE, Mocharnuk JW, Humar P, Zhang C, Rubin JP, Gusenoff JA. Analyzing the Impact of Social and Psychiatric Factors in Patients Who Undergo Body Contouring Procedures. Aesthet Surg J 2023; 44:NP119-NP124. [PMID: 37706281 DOI: 10.1093/asj/sjad297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/20/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND As the prevalence of obesity increases, the number of patients seeking body contouring procedures after bariatric surgery for massive weight loss is increasing. Although the positive impact of bariatric surgery on physical and emotional health is well-described, few studies have reported on the psychosocial well-being of patients undergoing body contouring procedures. Psychosocial well-being can impact patient satisfaction and maintenance of weight loss, and is an important area to study. OBJECTIVE The aim of this study was to characterize social and psychiatric factors of patients undergoing body contouring surgery, and to evaluate their impact on maintenance of weight loss. METHODS A retrospective review was performed of patients who presented to a single institution for body contouring procedures between 2002 and 2018. Demographic details, medical history, psychosocial support, and operative details were collected. Univariate analysis and multinomial logistic regressions were performed with R statistical software (version 1.3.1093). RESULTS A total of 1187 patients underwent at least 1 body contouring procedure during the study time frame. Mean BMI at presentation was 31.21 ± 10.49 kg/m2. Patients diagnosed with obesity at age 18 or older had significantly greater odds of suffering from generalized anxiety disorder (odds ratio [OR] 1.08 [95% CI, 1.02-1.15], P = .008). Patients with spousal support had 1.93 times higher odds of having maintained postbariatric weight loss at their 6-month follow-up (OR 1.93 [95% CI, 1.84-2.01], P = .028). CONCLUSIONS Social support and age of obesity diagnosis impact psychological well-being and maintenance of weight loss following body contouring procedures. LEVEL OF EVIDENCE: 3
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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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Greige N, Kamel GN, Leibl K, Jacobson J, Garfein ES, Weichman KE, Benacquista T. Analysis of Body Contouring and Sustained Weight Loss in a Diverse, Urban Population: A 7-Year Retrospective Review. Plast Reconstr Surg 2023; 151:1190-1199. [PMID: 36508474 PMCID: PMC10213083 DOI: 10.1097/prs.0000000000010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies demonstrating the positive impact of body contouring on sustained weight loss in bariatric patients describe a narrow cohort. The authors sought to evaluate the impact of postbariatric body contouring procedures on sustained weight loss in minority race patients. METHODS A retrospective review of bariatric surgery patients at a single institution was performed. Patients were grouped as follows: (1) those who underwent body contouring, (2) those who had consultation but did not undergo body contouring, and (3) those without consultation. Body mass index (BMI) and excess body weight loss (EBWL) over 7 years were the primary outcomes. RESULTS A TOTAL OF 2531 patients were analyzed: 350 in group 1, 364 in group 2, and 1817 in group 3. At postoperative year 7, groups 1 and 2 had average BMIs 4.71 and 2.31 kg/m 2 lower than group 3, respectively, while adjusting for covariates. After exclusion of 105 patients in group 2 who were not offered body contouring because of inadequate weight loss, however, group 2 had an average BMI 4.07 kg/m 2 lower than group 3 at postoperative year 7. During postoperative year 1, group 1 had an average EBWL of 74.38%, which declined 1.51% yearly, and group 2 had an average EBWL of 70.12%, which declined 1.86% yearly. After exclusion of the aforementioned patients, group 2 had an average EBWL of 74.9% at postoperative year 1, which declined 1.88% yearly. CONCLUSIONS Body contouring after bariatric surgery did not impart a clinically significant, long-term sustained weight loss benefit in the authors' cohort. In the authors' study population, patients identifying as black had significantly worse sustained weight loss. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Nicolas Greige
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
| | - George N. Kamel
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
| | - Kayla Leibl
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
| | - Joshua Jacobson
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
| | - Evan S. Garfein
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
| | - Katie E. Weichman
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
| | - Teresa Benacquista
- Montefiore Medical Center, Division of Plastic & Reconstructive Surgery; Bronx, NY
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Barbaro A, Kumar A, Asokan G, Green L, Ibrahim A, Goel R, Harries R, Kanhere H, Prowse P, Trochsler M. Quality of Life After Bariatric and Body Contouring Surgery in the Australian Public Health System. J Surg Res 2023; 285:76-84. [PMID: 36652771 DOI: 10.1016/j.jss.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The goals of bariatric surgery are weight loss, improved management of obesity-related diseases, and enhanced health-related quality of life (HRQoL). The aim of this study is to determine HRQoL among postoperative bariatric surgery patients. The aim of this study was to evaluate the utility of bariatric surgery and the role of body contouring surgery (BCS) when considering quality of life in low-volume centres in the Australian public health system. METHODS This cohort study compared patients who underwent bariatric surgery between 2008 and 2018, to those awaiting surgery. An additional analysis was completed for patients who also underwent BCS. Patients completed the Short Form-36 quality of life (SF-36) survey. Linear regression was used to assess the differences in mean scores between cohorts for each of the SF-36 domains. RESULTS A total of 131 postoperative patients were identified, with a follow up rate of 68%. The mean follow up was 5.4 y. The mean scores for all domains of the SF-36 in the postoperative group were higher than the preoperative group (P ≤ 0.0001). A significant difference in scores persisted after controlling for patients' current BMI. When considering patients who underwent BCS (n = 24), there was a further global improvement in HRQoL in physical function (P = 0.0065), role limitation to physical health (P = 0.0026), pain (P = 0.0004), energy (P = 0.0023) and general health perceptions (P = 0.0023). CONCLUSIONS Bariatric surgery followed by BCS may improve HRQoL for the patient when compared to bariatric surgery alone. We advocate for the use of bariatric surgery followed by BCS in low-volume centres in the Australian public health system.
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Affiliation(s)
- Antonio Barbaro
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Ajan Kumar
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Gayatri Asokan
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Luke Green
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Abdullah Ibrahim
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Raghav Goel
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Richard Harries
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Harsh Kanhere
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia
| | - Phoebe Prowse
- Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Markus Trochsler
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital Adelaide, Woodville South, Australia.
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Bosc L, Mathias F, Monsaingeon M, Gronnier C, Pupier E, Gatta-Cherifi B. Long-term changes in body image after bariatric surgery: An observational cohort study. PLoS One 2022; 17:e0276167. [PMID: 36477002 PMCID: PMC9728839 DOI: 10.1371/journal.pone.0276167] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND While body image improves in the first few months after surgery, data on long-term changes in body image after bariatric surgery are scarce and contradictory. METHODS We assessed body image through the Stunkard Figure Rating Scale and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale, which measures appearance evaluation and orientation, overweight preoccupation, and self-classified weight. Surveys were conducted before surgery and at regular intervals until 5 years after bariatric surgery. RESULTS 61 patients were included in the study. No patients were lost to follow-up until 18 months after bariatric surgery. At 5 years, there were 21 patients (34%) lost to follow-up. We detected an overall improvement in body image until 12-18 months post-surgery. Scores declined after 5 years post-surgery but were still higher than preoperative evaluations. Overweight preoccupation did not change throughout the follow-up period. There was a positive correlation between body weight lost and appearance evaluation. There was also a positive correlation between weight loss and the Body Areas Satisfaction Scale. There was a negative correlation between weight loss and overweight preoccupation. Appearance orientation and self-classified weight were not correlated with weight loss. CONCLUSIONS Body image improved after bariatric surgery but was not maintained for all 5 years after surgery.
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Affiliation(s)
- Laurène Bosc
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Flore Mathias
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Maud Monsaingeon
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Caroline Gronnier
- Digestive Surgery Department, Bordeaux University Hospital, Pessac, France
- University of Bordeaux, Bordeaux, France
| | - Emilie Pupier
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Blandine Gatta-Cherifi
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
- University of Bordeaux, Bordeaux, France
- Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, University of Bordeaux, U1215, Bordeaux, France
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Body Image and Body Mass Index Influence on Psychophysical Well-Being in Bariatric Patients: A Cross-Sectional Study. J Pers Med 2022; 12:jpm12101597. [PMID: 36294736 PMCID: PMC9604850 DOI: 10.3390/jpm12101597] [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: 09/05/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Psychophysical factors may have an impact on the disease of obesity, and it is important to explore which aspects may play an important role on the well-being of obese patients undergoing bariatric surgery. The purpose of this study was to assess the associations of a high body mass index (BMI) and greater dissatisfaction with body image with higher levels of psychopathological aspects, feelings of hopelessness, and psychological and physical health in patients undergoing evaluation for bariatric surgery. Methods: Fifty-nine patients undergoing bariatric surgery filled out the Symptom Checklist-90-Revised, the Body Uneasiness Test, the 12-item Short Form Survey, the Beck Inventory Scale II, and the Beck Hopelessness Scale. Correlations and hierarchical regressions between measures were performed. Results: Dissatisfaction with the perception of one’s own body image was strongly correlated with a worse psychophysiological health. On the contrary, BMI showed no significant correlation with the previous variables. Furthermore, the perception of one’s own body image significantly predicted the state of psychological health. Conclusions: The findings showed a more relevant role of body image compared to the BMI in the association with psychological outcomes, suggesting the importance of considering body image in the assessment and treatment of obese patients requiring bariatric treatment.
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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] [MESH Headings] [Grants] [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.
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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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10
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Zaussinger M, Wenny R, Zucal I, Staud C, Schmidt M, Duscher D, Huemer GM. The Three-Hour Lower Body Lift: Evolution of a Technique and Personal Experience after 155 Consecutive Cases. Aesthetic Plast Surg 2022; 46:1293-1302. [PMID: 34761290 DOI: 10.1007/s00266-021-02651-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Body-contouring is a surgical field in growing demand, as the number of massive weight loss patients following bariatric surgery is increasing. The purpose of this study was to provide a straightforward and time-efficient circumferential body lift technique to achieve optimal lower truncal contouring. PATIENTS AND METHODS A total of 155 massive weight loss patients (133 women and 22 men) underwent lower body lift surgery between 2006 and 2018. The mean preoperative weight reduction and body mass indices were 56.5 ± 16.6 kg and 26.7 ± 4.7 kg/m2, respectively. The preoperative markings focused on the back and gluteal region, and the modified surgical technique are described. Additionally, improvements of intra-operative repositioning of the patient and how to deal with sterilization and dressings are elucidated. RESULTS The average intra-operative time was 178 ± 54.6 minutes. The mean follow-up of all patients was 8.2 ± 2.4 years. The most common complications were related to wound dehiscence (n = 38) and seroma (n = 18). The mean weight of the resected tissue was 3 056 ± 1 816.5 g. CONCLUSION The lower body lift represents an effective and safe body contouring procedure to treat massive weight loss patients with multiple regions of concern. The current study describes a modified surgical technique that reduces operating time and complications, notably. 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 http://www.springer.com/00266 .
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Affiliation(s)
- Maximilian Zaussinger
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria.
| | - Raphael Wenny
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
| | - Isabel Zucal
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
| | - Clement Staud
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Manfred Schmidt
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
| | - Dominik Duscher
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Georg M Huemer
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria.
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Wan Makhtar WR, Mohamad Shah NS, Rusli SM, Mat Saad AZ, Wan Sulaiman WA. The Impact of Abdominoplasty vs Non-abdominoplasty on Weight Loss in Bariatric and Non-bariatric Malaysian Patients: A Multicentre Retrospective Study. Cureus 2022; 14:e23996. [PMID: 35547419 PMCID: PMC9085712 DOI: 10.7759/cureus.23996] [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] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aims Weight loss associated with abdominoplasty remains controversial as to whether it is contributed by the procedure alone, or if there are other patient factors. Therefore, we evaluated the relationship between weight loss in pre- and post-abdominoplasty and compared the weight loss of those who do not undergo abdominoplasty in bariatric and non-bariatric patients. Methods This study measured weight changes at designated time points in four different groups comprising 98 patients. The groups were abdominoplasty after bariatric surgery (group A), patients with abdominoplasty alone (B), bariatric surgery alone (group C), and diet alone (group D). Results are compared within and between the groups. Results Patients in groups A and B (patients who had abdominoplasty regardless with or without bariatric surgery) had a significant weight loss after six months (mean difference=10.70kg, 95% CI=4.05, 17.34, p<0.001) compared to pre abdominoplasty weight. Patients in group B were statistically significant (mean difference=4.01kg, 95% CI=0.92, 7.10, p=0.007) with 3.60kg weight reduction (4.59%). Patients in group A had clinically significant weight reduction (4.45kg, 5.14%) but it was not statistically significant (p>0.05) and had no significant additional weight reduction as compared to non-abdominoplasty (group C) patients (p=0.650). Patients in group C had a statistically significant difference from those in group D (F [1.00, 48.00] = 8.56, p=0.005) with an average weight loss of 3.60kg (4.59%) vs 2.56kg (2.8%) respectively. Conclusions All patients with abdominoplasty had significant weight loss after six months. Bariatric patients did not experience significant additional weight loss with abdominoplasty. Weight reduction after abdominoplasty alone was greater than diet alone.
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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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13
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Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review. SEXES 2022. [DOI: 10.3390/sexes3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.
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Fu R, Zhang Y, Yu K, Mao D, Su H. Bariatric surgery alleviates depression in obese patients: A systematic review and meta-analysis. Obes Res Clin Pract 2021; 16:10-16. [PMID: 34802982 DOI: 10.1016/j.orcp.2021.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND With the rapid increase in the incidence of depression, there have been studies investigating whether bariatric surgery can alleviate this condition. In this study, we aimed to explore the effect of bariatric surgery on depression in obese patients. METHODS We searched the PubMed, Embase, Web of Science and the Cochrane Library databases for studies on bariatric surgery and depression. Then, the clinical significance of bariatric surgery on depression was evaluated based on Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) or Patient Health Questionnaire (PHQ-9). Subgroup analysis was carried out in terms of surgery types, assessment tool, follow-up time and nationalism. Dichotomous data were analyzed using odds ratio (OR), and continuous data were evaluated using the weighted mean difference (WMD) or standardized mean difference (SMD). RESULTS Overall, 33 studies with a combined total of 12,556 participants met the inclusion criteria. Statistical results were significantly different whether continuous or dichotomous, and depression was improved in obese patients after surgery (SMD = -0.87, p < 0.001; and OR = 0.29, p < 0.001, respectively). In addition, subgroup analysis showed that bariatric surgery improved depression in obese patients regardless of surgery types, assessment tool, follow-up and country. CONCLUSION Bariatric surgery alleviates depression in obese patients. However, further studies are needed to elucidate on the complex effect of between bariatric surgery on depression.
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Affiliation(s)
- Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kepin Yu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hui Su
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
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Is body-contouring surgery a right for massive weight loss patients? A survey through the European Union National Health Systems. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background
Obesity is pandemic nowadays, and hanging skin with consequent functional and psychological impairments is a common price to pay for massive weight loss. Plastic surgery in postbariatric patients represents a fundamental step to regain possession of a positive self-image. The authors aimed to investigate how EU countries’ National Health System (NHS) behaves regarding reimbursements for body-contouring procedures after massive weight loss.
Methods
A 1-item survey was sent to contacts found on the NHS official Web sites of 27 EU countries. The question focused on postbariatric surgery practice and investigated the accessibility criteria for NHS coverage concerning body-contouring procedures after massive weight loss.
Results
Responses were collected between January 2020 and February 2020. Response rate was 65%, and access criteria to NHS coverage for postbariatric surgery presented great variation across EU countries. Only one country presented an NHS with no coverage for postbariatric surgeries.
Conclusions
Despite the conspicuous variability found among the EU NHS, none of them admit reimbursement in cases of merely aesthetic procedures: postbariatric patients need to display functional or health impairments due to the extensive weight loss. The results of the current study describe a complex situation among EU countries, but a common lead towards postbariatric patients’ care shows off. The ultimate goal of bariatric patient’s healing should be full restoration of physical and psychological well-being. NHS of EU countries are facing this increasing request in various ways, and more studies should be performed in order to understand which is the best approach.
Level of evidence: Not ratable.
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Edmondson SJ, Ross DA. The postpartum abdomen: psychology, surgery and quality of life. Hernia 2021; 25:939-950. [PMID: 34309770 DOI: 10.1007/s10029-021-02470-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The postpartum abdomen presents significant challenges to the surgeon. It is anatomically complex, with often substantial symptomatic divarication of the rectus abdominis, affecting all anterior abdominal wall layers. This may lead to profound functional sequelae, and often, of more importance to patients, a significant physical deformity. The complex interplay of functional/physical symptoms can result in reduced quality of life (QoL) as well as negative body image/self-esteem. Postpartum women may seek abdominoplasty to address the whole scope of these concerns. Whilst techniques have evolved achieving such goals operatively, the impact of such surgery on QoL/mental health has yet to be established. METHODS We perform a comprehensive review of potential options of validated patient-reported outcome measures (PROMs) for consideration of use in postpartum women seeking abdominoplasty; in addition to discussing current driving factors for seeking surgery and associated ethics. RESULTS Pressure on postpartum women to return their abdominal wall contour to a pre-pregnant state is high. This poses important ethical considerations for surgeons. There are several well-established/validated PROMs used in body contouring in massive weight loss/bariatric population groups, including Body-Q and Body-QoL scales, but none yet specific to postpartum women. CONCLUSION PROMs use to enable establishment of the true value of abdominoplasty in postpartum women, not just in terms of functional/physical restoration, but also in terms of delivering a positive impact on patients' mental health and QoL, are important. Further research is needed to determine if those already developed are appropriate or whether a postpartum-specific PROM would be beneficial.
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Affiliation(s)
- S-J Edmondson
- Plastic and Reconstructive Surgery Department, The London Clinic, 20 Devonshire Place, London, W1G 6BW, England.
| | - D A Ross
- Plastic and Reconstructive Surgery Department, The London Clinic, 20 Devonshire Place, London, W1G 6BW, England
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Yildiz E, Karagözoğlu Ş. The Effects of Nursing Education Constructed According to Roy Adaptation Model on Adaptation Process of Patients Undergoing Bariatric Surgery. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ezgi Yildiz
- Susehri School of Health Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey
| | - Şerife Karagözoğlu
- Faculty of Health Sciences Fundamentals of Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey
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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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Body Contouring Surgery Improves Physical Activity in Patients After Massive Weight Loss-a Retrospective Study. Obes Surg 2020; 30:146-153. [PMID: 31444775 DOI: 10.1007/s11695-019-04145-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare physical activity (PA) in patients who had undergone massive weight loss (MWL), before and after body contouring procedures. METHODS All patients undergoing body contouring surgery after MWL between 2007 and 2017 with a minimum follow-up of 6 months after the last procedure were included in this retrospective study. Excluded were those with a body mass index > 35 kg/m2 and those with comorbidities leading to impaired PA. Quality of life (QOL) was assessed using the Moorehead-Ardelt QOL Questionnaire II. Evaluation of PA was obtained with the International Physical Activity Questionnaire (IPAQ) short form and the Freiburg PA Questionnaire. Functional impairment during exercise was analyzed using a self-designed functional impairment score (FIS). RESULTS In the 45 patients completing the survey (37 female, 8 male), an improvement in QOL (p < 0.001) and PA scored by the IPAQ (p = 0.017) was found. The Freiburg PA Questionnaire showed no difference in PA before and after body contouring surgery (p = 0,274). Furthermore, scores of the FIS indicated a decrease of functional impairment during physical activity after body contouring surgery (p < 0.001). CONCLUSION Body contouring improves QOL and PA in patients after massive weight loss. The results of our study confirm the important role of plastic surgery in the treatment and maintenance of health of patients with former obesity.
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Makarawung DJS, Monpellier VM, van den Brink F, Woertman L, Zijlstra H, Mink van der Molen AB, van Ramshorst B, Geenen R. Body Image as a Potential Motivator for Bariatric Surgery: a Case-Control Study. Obes Surg 2020; 30:3768-3775. [PMID: 32451911 DOI: 10.1007/s11695-020-04685-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Not every eligible person opts for bariatric surgery. Body image concerns might be a reason to choose surgery. This case-control study evaluated differences in body image between a pre-bariatric surgery population and a weight-matched control group from the general population. We hypothesized that the pre-bariatric group would show less satisfaction with appearance, defined as a discrepancy between evaluating one's appearance as less attractive while attaching more importance to appearance. METHODS Data from 125 pre-bariatric patients were compared with 125 body weight-matched controls from the general population. The Multidimensional Body-Self Relations Questionnaire-Appearance Scales was used to assess appearance evaluation (AE), appearance orientation (AO), and their discrepancy score. Both groups were compared with norms from the non-body weight-matched general population. RESULTS The pre-bariatric group had lower AE scores (mean 2.23 ± 0.65 vs. mean 2.54 ± 1.06) and higher AO scores (mean 3.33 ± 0.69 vs. mean 3.04 ± 0.90) than the control group. The discrepancy between AE and AO was larger in the pre-bariatric group (p < 0.001). Compared with the general population, both groups showed lower AE scores (d = - 1.43 and d = - 1.12, p < 0.001) and lower AO scores (d = - 0.23 and d = - 0.58, p < 0.001). CONCLUSIONS People with morbid obesity have on average less body image satisfaction. The results indicate that part of the motivation of people that choose bariatric surgery may be due to relatively low global appearance evaluation combined with considering appearance more important. Knowledge about motivations can be used to communicate realistic expectations regarding treatment outcome.
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Affiliation(s)
- D J S Makarawung
- Department of Plastic Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands. .,Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands.
| | - V M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - F van den Brink
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - L Woertman
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - H Zijlstra
- Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | | | - B van Ramshorst
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - R Geenen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
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21
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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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Sandvik J, Hole T, Klöckner C, Kulseng B, Wibe A. The Impact of Post-bariatric Abdominoplasty on Secondary Weight Regain After Roux-en-Y Gastric Bypass. Front Endocrinol (Lausanne) 2020; 11:459. [PMID: 32849265 PMCID: PMC7406571 DOI: 10.3389/fendo.2020.00459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
Roux-en-Y gastric bypass (RYGB), implies a considerable weight loss during the first two years after surgery. Excess skin due to rapid weight loss might affect self-esteem, decrease quality of life and be a hindrance to physical activity. Removing excess skin might reduce secondary weight regain. Among plastic surgeons, a BMI <30 kg/m2 is usually required to have abdominoplasty (AP). Many RYGB patients never reach this threshold even if they have a considerable weight loss and experience practical as well as emotional problems due to excess skin. The aim of this study was to investigate the role of abominoplasty on weight development until five years, among patients who did and did not achieve a nadir BMI <30 kg/m2 during the first two years after RYGB. Data on 645 patients from a single center RYGB-quality register from 2004 to 2013 with baseline and follow-up data were analyzed. Post-bariatric AP was publicly funded if medically needed. Weight regain (WR) from nadir weight to five years was analyzed as percentage WR of maximal weight loss. Nadir BMI was available in 633 (98.1%) patients, and BMI after five years in 553 (85.7%) patients. The 233 patients with nadir BMI <30 kg/m2 who underwent AP regained 17.8 (±16.1) % of their maximal weight loss at five years compared to 24.2 (±19.7) % in 185 patients not having AP (p < 0.001). The 27 patients with nadir BMI > 30 kg/m2 within two years after RYGB who underwent AP regained 12.9 (±19.3) % compared to 31.4 (±24.7) % in 188 patients without AP (p < 0.001). This procedure was more common among women than men, as 224 (46.4%) women, and 36 (22.2%) men underwent AP. Abdominoplasty was associated with reduced secondary weight regain after RYGB in this study. Whether this is caused by increased bodily satisfaction and better physical function, or a biological response to reduction of adipose tissue remains unclear. If removing abdominal subcutaneous adipose tissue prevent secondary weight regain and increase the robustness of bariatric surgery, this should be offered as part of the standard treatment after bariatric surgery.
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Affiliation(s)
- Jorunn Sandvik
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Alesund, Norway
- Department of Surgery, Center for Obesity, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Jorunn Sandvik ;
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Alesund, Norway
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christian Klöckner
- Department of Surgery, Center for Obesity, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Bård Kulseng
- Department of Surgery, Center for Obesity, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Wibe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
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Ganci M, Suleyman E, Butt H, Ball M. The role of the brain-gut-microbiota axis in psychology: The importance of considering gut microbiota in the development, perpetuation, and treatment of psychological disorders. Brain Behav 2019; 9:e01408. [PMID: 31568686 PMCID: PMC6851798 DOI: 10.1002/brb3.1408] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The prevalence of psychological disorders remains stable despite steady increases in pharmacological treatments suggesting the need for auxiliary treatment options. Consideration of the brain-gut-microbiota axis (BGMA) has made inroads into reconceptualizing psychological illness from a more holistic perspective. While our understanding of the precise role of gut microbiota (GM) in psychological illness is in its infancy, it represents an attractive target for novel interventions. METHOD An extensive review of relevant literature was undertaken. RESULTS Gut microbiota are proposed to directly and indirectly influence mood, cognition, and behavior which are key components of mental health. This paper outlines how GM may be implicated in psychological disorders from etiology through to treatment and prevention using the Four P model of case formulation. CONCLUSION Moving forward, integration of GM into the conceptualization and treatment of psychological illness will require the discipline of psychology to undergo a significant paradigm shift. While the importance of the GM in psychological well-being must be respected, it is not proposed to be a panacea, but instead, an additional arm to a multidisciplinary approach to treatment and prevention.
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Affiliation(s)
- Michael Ganci
- Psychology Department, Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - Emra Suleyman
- Psychology Department, Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - Henry Butt
- Bioscreen Yarraville (Aust) Pty Ltd, Melbourne, Vic., Australia.,Melbourne University, Melbourne, Vic., Australia
| | - Michelle Ball
- Psychology Department, Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
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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: 52] [Impact Index Per Article: 10.4] [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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Lu N, Adambekov S, Edwards RP, Ramanathan RC, Bovbjerg DH, Linkov F. Relationships Between a History of Abuse, Changes in Body Mass Index, Physical Health, and Self-Reported Depression in Female Bariatric Surgery Patients. Bariatr Surg Pract Patient Care 2019; 14:113-119. [PMID: 31572626 DOI: 10.1089/bari.2018.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background/Objectives: A history of physical and sexual abuse has been implicated in weight gain. Although bariatric surgery is effective for weight loss in severely obese individuals, we investigated whether bariatric surgery patients who self-report a history of physical and/or sexual abuse have differential outcomes regarding weight loss, body mass index (BMI), quality of life (SF-36), and depressive symptoms (Center for Epidemiologic Studies Depression [CESD]) compared with nonabused patients. Materials and Methods: Standardized assessments at baseline and follow-up visits were performed on 103 obese (BMI >35) female bariatric surgery patients (mean age: 44.11 years, standard deviation: 11.67 years). Results: In total 49.5% of participants reported abuse. Abused group had significantly higher BMI (p < 0.01) and depression scores (p < 0.01). After surgery, the BMI between the two groups was no longer significantly different, although the abused group remained significantly more depressed. Mixed models showed that abuse was associated with CESD scores (p < 0.01) and SF-36 mental composite scores (p = 0.03) after adjusting for smoking history. Conclusion: Bariatric surgery leads to a better weight loss in abused patients. Abuse history might be an additional factor for clinicians to consider when advising bariatric surgery, as our study suggests that women with history of abuse may have a higher weight loss benefit but less mental health improvement from the intervention.
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Affiliation(s)
- Nancy Lu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shalkar Adambekov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ramesh C Ramanathan
- Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dana H Bovbjerg
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Faina Linkov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Renno I, Boos AM, Horch RE, Ludolph I. Changes of perfusion patterns of surgical wounds under application of closed incision negative pressure wound therapy in postbariatric patients1. Clin Hemorheol Microcirc 2019; 72:139-150. [DOI: 10.3233/ch-180450] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Isabell Renno
- Department of Plastic and Hand Surgery University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anja M. Boos
- Department of Plastic and Hand Surgery University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Plastic Surgery, Hand and Burn Surgery University Hospital of Aachen, RWTH University of Aachen, Aachen, Germany
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
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Yılmaz P, Yılmaz M. Effect on Quality of Life of the Changing Body Image of Individuals with Obesity Surgery. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Pınar Yılmaz
- Department of Surgery Nursing, Sivas Cumhuriyet University, Sivas, Turkey
| | - Meryem Yılmaz
- Department of Surgery Nursing, Sivas Cumhuriyet University, Sivas, Turkey
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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
BACKGROUND Opioid misuse occurs commonly among obese patients and after bariatric surgery. However, the risk of new persistent use following postbariatric body contouring procedures remains unknown. METHODS The authors examined insurance claims from Clinformatics Data Mart (OptumInsight, Eden Prairie, Minn.) between 2001 and 2015 for opioid-naive patients undergoing five body contouring procedures: abdominoplasty/panniculectomy, breast reduction, mastopexy, brachioplasty, and thighplasty (n = 11,257). Their primary outcomes included both new persistent opioid use, defined as continued prescription fills between 90 and 180 days after surgery, and the prevalence of high-risk prescribing. They used multilevel logistic regression to assess the risk of new persistent use, adjusting for relevant covariates. RESULTS In this cohort, 6.1 percent of previously opioid-naive patients developed new persistent use, and 12.9 percent were exposed to high-risk prescribing. New persistent use was higher in patients with high-risk prescribing (9.2 percent). New persistent use was highest after thighplasty (17.7 percent; 95 percent CI, 0.03 to 0.33). Increasing Charlson comorbidity indices (OR, 1.11; 95 percent CI, 1.05 to 1.17), mood disorders (OR, 1.27; 95 percent CI, 1.05 to 1.54), anxiety (OR, 1.41; 95 percent CI, 1.16 to 1.73), tobacco use (OR, 1.22; 95 percent CI, 1.00 to 1.49), neck pain (OR, 1.23; 95 percent CI, 1.04 to 1.46), arthritis (OR, 1.30; 95 percent CI, 1.08 to 1.58), and other pain disorders (OR, 1.36; 95 percent CI, 1.16 to 1.60) were independently associated with persistent use. CONCLUSIONS Similar to other elective procedures, 6 percent of opioid-naive patients developed persistent use, and 12 percent were exposed to high-risk prescribing practices. Plastic surgeons should remain aware of risk factors and offer opioid alternatives. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Oliveira CFDA, Dos Santos PO, de Oliveira RA, Leite-Filho H, de Almeida Oliveira AF, Bagano GO, Lima Junior EB, Miranda EP, de Bessa Junior J, Barroso Junior U. Changes in Sexual Function and Positions in Women With Severe Obesity After Bariatric Surgery. Sex Med 2018; 7:80-85. [PMID: 30509513 PMCID: PMC6377367 DOI: 10.1016/j.esxm.2018.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/07/2023] Open
Abstract
Introduction Severe obesity is most effectively treated with bariatric surgery. The resulting weight loss is expected to improve a variety of obesity-related conditions, including sexual dysfunction. Aim To analyze changes in the sexual function of women with obesity following bariatric surgery. Methods A prospective study was conducted between April 2015 and April 2016 involving 62 women with obesity who underwent Roux-en-Y gastric bypass. The Female Sexual Function Index (FSFI) was used to evaluate sexual function. Sexual dysfunction was defined as an FSFI score below 26.55. Patients’ clinical and demographic data were recorded. Sexual frequency of 12 different sexual positions was also evaluated. Main Outcome Measure Sexual dysfunction prevalence and the frequency of sexual positions before and 6 months after surgery. Results The prevalence of sexual dysfunction decreased from 62% before surgery to 19% 6 months after the procedure. There was a 19.2% improvement in the mean overall FSFI score (P < .01). 6 months after surgery, the mean overall FSFI score had improved in all patients, with a statistically significant change being found in all 6 domains of the questionnaire (P < .05). There was an increase in the frequency of 3 of 12 sexual positions evaluated. Conclusion Sexual function in women with obesity effectively improves after bariatric surgery. Favorable changes following weight loss included a significant reduction in the prevalence of sexual dysfunction and an increase in the frequency of different sexual positions during intercourse. Oliveira CFA, dos Santos PO, Oliveira RA, et al. Changes in sexual function and positions in women with severe obesity after bariatric surgery. Sex Med 2019;7:80–85.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ubirajara Barroso Junior
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; Universidade Federal da Bahia, Salvador, BA, Brazil
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de Vries CEE, Kalff MC, Prinsen CAC, Coulman KD, den Haan C, Welbourn R, Blazeby JM, Morton JM, van Wagensveld BA. Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review. Obes Rev 2018; 19:1395-1411. [PMID: 29883059 DOI: 10.1111/obr.12710] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS). METHODS We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A-D). RESULTS Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D). CONCLUSION The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials.
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Affiliation(s)
- C E E de Vries
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - M C Kalff
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C den Haan
- Medical Library, OLVG, Amsterdam, The Netherlands
| | - R Welbourn
- Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
| | - J M Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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The Role of Appearance: Definition of Appearance-Pain (App-Pain) and Systematic Review of Patient-Reported Outcome Measures Used in Literature. Aesthetic Plast Surg 2018; 42:1399-1409. [PMID: 29922843 DOI: 10.1007/s00266-018-1158-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The objectives of the current study were: (1) to perform a systematic review of the existing scientific literature on appearance and any subsequently related disorders and (2) to research in the literature the correlation between the role of appearance and patient's disease. MATERIALS AND METHODS A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidance. A multistep search of the PubMed, MEDLINE, PreMEDLINE, Embase, Ebase, CINAHL, PsychINFO and Cochrane databases was performed to identify studies on patient satisfaction, quality of life, and body image. RESULTS Our search generated a total of 347 articles. We performed a systematic review of the 18 studies, which had sufficient data and met all inclusion criteria. All studies identified from the literature review were assessed to determine the utilization of validated patient satisfaction questionnaires. The questionnaires were analyzed 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 27 individual questionnaires. We summarized development and validation characteristics and content of the 27 validated measures used in the studies. CONCLUSIONS This is the first systematic review to identify and critically appraise patient-reported outcome measures for appearance and body image using internationally accepted criteria. DAS59 was deemed to have adequate levels of methodological and psychometric evidence. We also introduced the concept of Appearance-Pain which consists of the recomposed systematic view of the experimental indicators of suffering, linked to one of the dimensions of appearance. 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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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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Dreifuss SE, Beidas OE, Rubin JP, Gusenoff JA. Characterizing the Saddlebag Deformity After Lower Body Lift. Aesthet Surg J 2018; 38:1115-1123. [PMID: 29741579 DOI: 10.1093/asj/sjy105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One of the commonly cited sequelae of lower body lift is recurrence of the saddlebag deformity. However, there are currently no data that characterize the evolution of the saddlebag following lower body lift, nor is there a classification scheme to objectively quantify the severity of the deformity. OBJECTIVES The authors aimed to develop a grading scale to score the severity of the saddlebag deformity and, using this, determine the short- and long-term changes in the saddlebag following lower body lift. METHODS Using the Pittsburgh Rating Scale, the Pittsburgh Saddlebag Rating Scale, a 4-point Likert scale, was developed to score the saddlebag deformity. Patients who underwent lower body lifts were parsed from a prospectively maintained database. Two educated observers independently reviewed both preoperative and postoperative photographs and graded the saddlebag deformity according to the Pittsburgh Saddlebag Rating Scale. RESULTS Seventy-nine patients met inclusion criteria, including 5 males and 74 females. The average saddlebag score preoperatively was 1.34, while the average scores at short- and long-term follow up were 1.28 and 1.42, respectively. No significant differences in saddlebag severity scores were noted between preoperative and short- or long-term postoperative time points (P > 0.05). CONCLUSIONS This is the first study to objectively demonstrate the postoperative changes in the saddlebag following lower body lift. Results demonstrated that lower body lift does not effectively treat the saddlebag as the deformity only slightly improved in the short-term window but recurred within a year of surgery. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Stephanie E Dreifuss
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Omar E Beidas
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Ivezaj V, Grilo CM. The complexity of body image following bariatric surgery: a systematic review of the literature. Obes Rev 2018; 19:1116-1140. [PMID: 29900655 PMCID: PMC6296375 DOI: 10.1111/obr.12685] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 12/16/2022]
Abstract
Poor body image is common among individuals seeking bariatric surgery and is associated with adverse psychosocial sequelae. Following massive weight loss secondary to bariatric surgery, many individuals experience excess skin and associated concerns, leading to subsequent body contouring procedures. Little is known, however, about body image changes and associated features from pre-to post-bariatric surgery and subsequent body contouring. The objective of the present study was to conduct a comprehensive literature review of body image following bariatric surgery to help inform future clinical research and care. The articles for the current review were identified by searching PubMed and SCOPUS and references from relevant articles. A total of 60 articles examining body image post-bariatric surgery were identified, and 45 did not include body contouring surgery. Overall, there was great variation in standards of reporting sample characteristics and body image terms. When examining broad levels of body image dissatisfaction, the literature suggests general improvements in certain aspects of body image following bariatric surgery; however, few studies have systematically examined various body image domains from pre-to post-bariatric surgery and subsequent body contouring surgery. In conclusion, there is a paucity of research that examines the multidimensional elements of body image following bariatric surgery.
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Affiliation(s)
- V Ivezaj
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - C M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Abstract
In the majority of patients with morbid obesity, metabolic/bariatric surgery leads to relevant and sustained weight loss and improves obesity-related comorbidities, quality of life and functionality. Moreover, the associated reduction of risk factors for cardiovascular events and cancerous diseases has been shown to improve life expectations. Due to its excellent antidiabetic effect, the currently valid national S3 guidelines now recommend metabolic/bariatric surgery in patients who have a body mass index (BMI) ≥30 kg/m2 with poorly controlled diabetes. The Edmonton staging system enables a multidimensional consideration of the severity grade of obesity for each individual patient independent of the BMI. Patients with relevant obesity-related metabolic comorbidities should be prioritized for treatment and if possible before the occurrence of end-organ damage that is at least in some cases irreversible and which also increases the perioperative risk. Therapeutic goals for each individual patient should be carefully defined preoperatively in order to mediate realistic expectations. Unrealistic expectations, such as "surgery solves my problems", "surgery makes me more beautiful", "surgery eliminates stigma", and "surgery guarantees success", are common in bariatric surgery patients. These unrealistic expectations can lead to frustration and to severe psychological decompensation and need to be addressed as early as possible by an interdisciplinary team. Redundancies, conclusive and empathic communication in the team improve therapy adherence, the expectations and therefore the overall outcome.
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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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Accardi R, Fave AD, Ronchi S, Terzoni S, Racaniello E, Destrebecq A. The Role of Quality of Life Instruments in Obesity Management: Review. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roberto Accardi
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvia Ronchi
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | - Emanuela Racaniello
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Psychological and Psychiatric Traits in Post-bariatric Patients Asking for Body-Contouring Surgery. Aesthetic Plast Surg 2017; 41:90-97. [PMID: 28032161 DOI: 10.1007/s00266-016-0752-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUNDS Obese patients, mainly females, feel uncomfortable and unsatisfied with their physical appearance; they have a wrong perception of their image and consequently diminish their self-esteem, sometimes showing difficulties in functional areas such as work, relationship, social activity. Beside health concerns, improving their appearance and body image are often common motives for weight loss in obese individuals and after weight loss about 30% of bariatric surgery patients undergo plastic surgical correction of excessive skin. The authors investigated psychological and psychiatric traits in post-bariatric patients undergoing body-contouring surgery to underline the strong correlation between psychiatry and obesity and avoid unsatisfactory results in post-bariatric patients. METHODS The Mini International Neuropsychiatric Interview, Beck Depression Inventory II, Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder Tridimensional Personality Questionnaire, Body Uneasiness Test, Barratt Impulsiveness Scale 11, and Binge Eating Scale were performed in 36 post-bariatric patients looking for plastic surgery and 21 controls, similar for clinical features, not seeking shape remodelling. RESULTS Much different psychiatric pathology characterizes cases, including current body dysmorphic disorder and previous major depression and anxiety disorders, impulsivity, binging and body uneasiness are other common traits. CONCLUSIONS In post-obesity rehabilitation, a strong collaboration between the plastic surgeon and psychiatrist is recommended to reduce the number of non-compliant patients. Preoperative psychological assessment of the body-contouring patient should be a central part of the initial plastic surgery consultation, as it should be for all plastic surgery patients. LEVEL OF EVIDENCE II 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 http://www.springer.com/00266 .
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En busca de la imagen corporal deseada después de la cirugía bariátrica. ENFERMERÍA UNIVERSITARIA 2017. [DOI: 10.1016/j.reu.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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