Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

ROSA, SIMONE CORRÊA; MACEDO, JEFFERSON LESSA SOARES DE; FREITAS, FLÁVIO GONDIM; FERREIRA, JOÃO LUIZ DARQUES; CANEDO, LUCAS RIBEIRO; CASULARI, LUIZ AUGUSTO

doi:10.5935/2177-1235.2018RBCP0146

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 33 (3) • 2018 • https://doi.org/10.5935/2177-1235.2018RBCP0146 copy

Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin.

Methods:

A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications.

Results:

For this study, 107 patients who underwent AP were included. The patients’ mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBG- RYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications.

Conclusions:

VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB.

Keywords:
Bariatric surgery; Postoperative care; Abdominoplasty; Reconstructive surgical procedures; Gastroplasty.

Characteristics	Mean	SD^* ***** Data are expressed as mean ± standard deviation.
Age (years)	40.89	9.76
Maximum weight (kg)	120.79	24.19
Maximum BMI^* * BMI: Body Mass Index. (kg/m²)	45.52	7.55
Final BMI before abdominoplasty (kg/m²)	27.63	3.70
Total weight loss (kg)	47.70	17.32
%EWL^ %EWL: Excess Weight Loss.	78.79	12.61

BMI (kg/m²)	Before bariatric surgery, number of patients (%)	Before abdominoplasty, number of patients (%)
<25 (normal)	0	21 (19.6%)
25.0-29.9 (overweight)	0	60 (56.1%)
30.0-4.9 (grade I)	0	24 (22.4%)
35.0-39.9 (grade II)	22 (20.6%)	1 (0.9%)
>40.0 (grade III)	85 (79.9%)	1 (0.9%)

Comorbidities	Before bariatric surgery, number of patients (%)	Before abdominoplasty, number of patients (%)	Valor p
Metabolic syndrome	61 (56.5%)	6 (5.6%)	0.027
Hypertension	59 (54.6%)	12 (11.1%)	0.001
Arthropathy	42 (38.9%)	5 (4.6%)	0.004
Diabetes mellitus	41 (38.0%)	6 (5.6%)	0.002
Depression/anxiety	40 (37.0%)	27 (25.0%)	0.001
Dyslipidemia	26 (24.1%)	2 (1.9%)	0.010
Sleep apnea syndrome	22 (20.4%)	2 (1.9%)	0.005
Esophagitis	22 (20.4%)	4 (3.8%)	0.005

Variables	Presence of complications	Absence of complications	p-value	OR	95% CI
Patients (N)	34	73	-	-	-
Age (years)^a	43.09 ± 12.1	39.9 ± 8.4	0.058	-	-
Age >40 years	73.5%	47.3	0.011^* ***** p < 0.05.	2.22	[1.15-4.30]
Mean maximum weight before bariatric surgery (kg)^a	129.4 ± 30.6	116.5 ± 19.5	0.010^* ***** p < 0.05.	-	-
Maximum BMI before bariatric surgery (kg/m²)^a	48.5 ± 9.6	44.1 ± 5.9	0.004^* ***** p < 0.05.	-	-
Mean BMI before abdominoplasty (kg/m²)^a	28.5 ± 4.4	27.2 ± 3.3	0.094	-	-
Mean ∆BMI (kg/m²)^a	19.7 ± 7.5	16.9 ± 4.9	0.022^* ***** p < 0.05.	-	-
Total weight loss (kg)^a	54.5 ± 23.1	44.3 ± 12.9	0.004^* ***** p < 0.05.	-	-
Lost weight ≥50 kg	50.1%	31.0%	0.059	1.70	[0.98;2.94]
∆BMI > 20 kg/m²	47.0%	27.0%	0.040^* ***** p < 0.05.	1.78	[1.03;3.06]
BMI before abdominoplasty > 30 kg/m²	24.32%	21.57%	0.818	-	-

Variables	Presence of complications	Absence of complications	p-value	OR	95% CI
Weight of the flap removed from the abdomen (g)^a	2743 ± 1601	1630.1 ± 846	<0.001^* ***** p < 0.05.	-	-
Weight of the removed flap of ≥2,000 g^* * Weight of the abdominal flap removed during abdominoplasty.	61.8%	25.7%	0.004^* ***** p < 0.05.	3.41	[2.11; 5.56]
Diabetes	11.8%	2.7%	0.056	2.27	[1.19;4.30]
Hypertension	17.7%	8.1%	0.143	1.71	[0.90;3.27]
Dyslipidemia	5.9%	0.0%	0.035^* ***** p < 0.05.	3.31	[2.48;4.42]
Metabolic syndrome	11.8%	2.7%	0.056	2.27	[1.19-4.30]
Diabetes/hypertension^ Presence of diabetes and/or hypertension.	26.5%	8.1%	0.011^* ***** p < 0.05.	2.23	[1.31-3.80]

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[1] *Corresponding author: Jefferson Lessa Soares de Macedo, SQS 213, Bloco H, Apto 303 - Asa Sul, Brasília, DF, Brazil Zip Code 70292-080, E-mail: jlsmacedo@yahoo.com.br

SCR	Analysis and/or interpretation of data; final approval of the manuscript; conception and design of the study.
JLSM	Final approval of the manuscript; conception and design of the study; completion of surgeries and/or experiments.
LAC	Analysis and/or interpretation of data; final approval of the manuscript.
FGF	Analysis and/or interpretation of data; final approval of the manuscript.
JLDF	Analysis and/or interpretation of data; final approval of the manuscript.
LRC	Statistical analyses; writing the manuscript or critical review of its contents.

SCR	Análise e/ou interpretação dos dados; aprovação final do manuscrito; concepção e desenho do estudo.
JLSM	Aprovação final do manuscrito; concepção e desenho do estudo; realização das operações e/ou experimentos.
LAC	Análise e/ou interpretação dos dados; aprovação final do manuscrito.
FGF	Análise e/ou interpretação dos dados; aprovação final do manuscrito.
JLDF	Análise e/ou interpretação dos dados; aprovação final do manuscrito.
LRC	Análise estatística; redação do manuscrito ou revisão crítica de seu conteúdo.