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Edwards MA, Powers K, Vosburg RW, Zhou R, Stroud A, Obeid NR, Pilcher J, Levy S, McArthur K, Basishvili G, Rosenbluth A, Petrick A, Lin H, Kindel T. American Society for Metabolic and Bariatric Surgery: postoperative care pathway guidelines for Roux-en-Y gastric bypass. Surg Obes Relat Dis 2025; 21:523-536. [PMID: 39965985 DOI: 10.1016/j.soard.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 12/31/2024] [Accepted: 01/12/2025] [Indexed: 02/20/2025]
Abstract
BACKGROUND Clinical care pathways and guidelines help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety (QIPS) Committee of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG), preoperative care of patients undergoing Roux-en-Y gastric bypass (RYGB), and most recently, intraoperative care of patients undergoing RYGB. OBJECTIVES This current RYGB care pathway guideline was created to address postoperative care guidance. SETTING Academic Health Center. METHODS For this systematic review, PubMed queries were performed from January 1979 to December 2019. Follow-up queries were performed from January 2020 to July 2024. Peer-reviewed publications were reviewed according to the level of evidence (LoE) regarding specific key questions developed by the QIPS Committee and working group for this pathway. RESULTS Evidence-based recommendations are made for the postoperative care of patients undergoing RYGB, including recommendations for early postoperative care, postoperative medication management, and long-term postoperative surveillance. CONCLUSIONS This document may provide a structure to providers based on current evidence for the postoperative care of patients with overweight or obesity undergoing RYGB.
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Affiliation(s)
| | - Kinga Powers
- Department of Surgery, Stony Brook Medicine, Stony Brook, New York
| | - R Wesley Vosburg
- Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Randal Zhou
- Department of Surgery, Yale University, New Haven, Connecticut
| | - Andrea Stroud
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Nabeel R Obeid
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - John Pilcher
- Department of Surgery, Sage Bariatric Institute, San Antonio, Texas
| | - Shauna Levy
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | | | - Givi Basishvili
- Department of Metabolic and Bariatric Surgery, Valley Health, Winchester, Virginia
| | - Amy Rosenbluth
- Department of Surgery, Stony Brook Medicine, Stony Brook, New York
| | - Anthony Petrick
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Henry Lin
- Department of Surgery, Signature Healthcare, Brockton, Massachusetts
| | - Tammy Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Bouhadana G, ElHawary H, Alam P, Gilardino MS. A Procedure and Complication-Specific Assessment of Smoking in Aesthetic Surgery: A Systematic Review and Meta-Analysis. Plast Surg (Oakv) 2024; 32:115-126. [PMID: 38433792 PMCID: PMC10902487 DOI: 10.1177/22925503221085083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background: The popularity of aesthetic surgery is on the rise, as is patients' expectations towards excellent surgical results. In order to meet these expectations, risk factors that hinder desired outcomes, such as smoking, need to be identified and addressed. To that end, the present study summarizes an updated systematic review focused on the effects of smoking on cosmetic surgical procedures and outcomes. Methods: A systematic review of studies comparing aesthetic surgical outcomes by procedure, between tobacco smokers and non-smokers was carried out, querying PubMed, Embase and the Cochrane databases. Data regarding surgical outcomes were extracted and meta-analyzed by a random effects model in conjunction with the Mantel-Haenszel statistical method. Results: Eighty-two studies were included in the final synthesis. Abdominoplasty/panniculectomy (n = 19 cohorts) and breast reduction (n = 27 cohorts) were the most common types of procedures included in this review. Other than mastopexy and rhinoplasty, smoking conferred a statistically significant increased risk of overall complications for all studied aesthetic procedures. Conclusions: The data demonstrates that smoking is a clear risk factor for the vast majority of aesthetic plastic surgeries studied. Although our meta-analysis suggests that smoking is not a risk factor for complications in mastopexies and rhinoplasties, these two specific analyses may have been biased, and should therefore be re-evaluated with future additional evidence. The results of this systematic review confirm the importance of smoking cessation and education relative to the outcomes of common cosmetic surgical procedures.
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Affiliation(s)
| | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter Alam
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Montesanti B, Kahhaleh E, De Mey A. Experience of abdominoplasty and analysis of the risk factors. Acta Chir Belg 2022; 122:1-6. [PMID: 34866546 DOI: 10.1080/00015458.2021.2014034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We performed a retrospective study of patients who underwent abdominoplasty to determine the predisposing factors for complications. METHODS Between 2013 and 2016, 235 patients underwent abdominoplasty at the Brugmann University Hospital. The risk factors for the complications studied were: sex, body mass index (BMI)≥30, active smoking, diabetes, high blood pressure, previous abdominal surgery, weight loss, other associated surgical procedures, liposuction, muscle diastasis correction and the duration of presence of the suction drains. The complications were divided into three groups: major complications requiring a second intervention within the first 15 days, minor complications only requiring local treatment and aesthetic complications corrected at a later stage. RESULTS Complications were observed in 46.5% of the patients: 19% were major complications, 69% minor complications and 12% aesthetic complications. The significant risk factors for complications were: BMI ≥30, weight loss, associated surgical procedures and suction drains left in place for more than 3 days. We also analysed combinations of risk factors and we found, for example, that certain combinations such as active smoking and previous abdominal surgery increased the risk significantly. CONCLUSIONS Abdominoplasty is a common plastic surgery procedure associated with an increased risk for complications in certain patients. In our study, a high complication rate was observed, probably because our population was mostly obese and many cases needed an additional procedure. There are no clear guidelines for the surgeon to choose the best surgical candidate. However, risk factors should be taken into consideration and explained to the patient before the surgical decision.
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King WC, White GE, Belle SH, Yanovski SZ, Pomp A, Pories WJ, Wolfe BM, Ahmed B, Courcoulas AP. Changes in Smoking Behavior Before and After Gastric Bypass: A 7-year Study. Ann Surg 2022; 275:131-139. [PMID: 32084036 DOI: 10.1097/sla.0000000000003828] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate smoking history and change in smoking behavior, from 1 year before through 7 years after Roux-en-Y gastric bypass (RYGB) surgery, and to identify risk factors for post-surgery smoking. BACKGROUND Smoking behavior in the context of bariatric surgery is poorly described. METHODS Adults undergoing RYGB surgery entered a prospective cohort study between 2006 and 2009 and were followed up to 7 years until ≤2015. Participants (N = 1770; 80% female, median age 45 years, median body mass index 47 kg/m2) self-reported smoking history pre-surgery, and current smoking behavior annually. RESULTS Almost half of participants (45.2%) reported a pre-surgery history of smoking. Modeled prevalence of current smoking decreased in the year before surgery from 13.7% [95% confidence interval (CI) = 12.1-15.4] to 2.2% (95% CI = 1.5-2.9) at surgery, then increased to 9.6% (95% CI = 8.1-11.2) 1-year post-surgery and continued to increase to 14.0% (95% CI = 11.8-16.0) 7-years post-surgery. Among smokers, mean packs/day was 0.60 (95% CI = 0.44-0.77) at surgery, 0.70 (95% CI = 0.62-0.78) 1-year post-surgery and 0.77 (95% CI = 0.68-0.88) 7-years post-surgery. At 7-years, smoking was reported by 61.7% (95% CI = 51.9-70.8) of participants who smoked 1-year pre-surgery (n = 221), 12.3% (95% CI = 8.5-15.7) of participants who formerly smoked but quit >1 year pre-surgery (n = 507), and 3.8% (95% CI = 2.1-4.9) of participants who reported no smoking history (n = 887). Along with smoking history (ie, less time since smoked), younger age, household income <$25,000, being married or living as married, and illicit drug use were independently associated with increased risk of post-surgery smoking. CONCLUSION Although most adults who smoked 1-year before RYGB quit pre-surgery, smoking prevalence rebounded across 7-years, primarily due to relapse.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gretchen E White
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Sciences University, Portland, Oregon
| | - Bestoun Ahmed
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Wiser I, Plonski L, Shimon N, Friedman T, Heller L. Surgical Site Infection Risk Factor Analysis in Postbariatric Patients Undergoing Body Contouring Surgery: A Nested Case-Control Study. Ann Plast Surg 2020; 82:493-498. [PMID: 30950874 DOI: 10.1097/sap.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) following body-contouring plastic surgery pose a significant burden on patients and caregivers, possibly leading to undesired surgical outcomes. Surgical site infection incidence following body-contouring plastic surgery ranges from 2% to 7%, but is estimated much higher among postbariatric massive weight loss (MWL) patients. OBJECTIVE The aim of this study was to evaluate SSI rate, risk and protective factors among postbariatric MWL patients following body-contouring plastic surgery. METHODS This was a nested case-control study of MWL patients who underwent body-contouring plastic surgery at the Department of Plastic Surgery at Assaf Harofeh Medical Center, between 2007 and 2014. Data were obtained from medical records. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Logistic regression was conducted to assess independent risk factors for SSIs. RESULTS From a cohort of 172 patients, 86 were included in the study. Surgical site infection rate was 20% (n = 17). Significant SSI risk factors included lifetime maximal weight and lifetime maximal body mass index (P = 0.039 and P = 0.002, respectively), body mass index loss prior to surgery (P = 0.032), estimated blood loss during surgery (P = 0.002), and gynecomastia repair procedure (P = 0.038). Independent SSI-associated factors included thigh lift procedure (odds ratio, 4.66; 95% confidence interval, 1.13-19.28) and preoperative antimicrobial prophylaxis (odds ratio, 0.04; 95% confidence interval, 0.03-0.61). CONCLUSIONS Although not required by current guidelines for body-contouring plastic surgery, preoperative antimicrobial prophylaxis in our study demonstrated a significant protective effect against SSIs. Further research may reveal its true contribution to SSI prevention in body-contouring plastic surgery.
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Affiliation(s)
| | - Lori Plonski
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Nitai Shimon
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Tali Friedman
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Lior Heller
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
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Romano L, Zoccali G, Orsini G, Giuliani M. Reducing complications in post-bariatric plastic surgery: our experience and literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:475-481. [PMID: 31910172 PMCID: PMC7233755 DOI: 10.23750/abm.v90i4.7405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/04/2019] [Indexed: 11/23/2022]
Abstract
Background: With the rise in obesity, there has been a similar increase in bariatric surgery. This resulted in numerous patients losing significant weight with accompanying circumferential body contouring issues. This has led to an amazing increase in the number of body contouring procedures performed. Methods: The aim of this work is to revise the cases of body contouring in 78 ex-obese patients who underwent body contouring surgery in the Department of Health Life and Environmental Sciences – Plastic Reconstructive and Aesthetic Plastic Surgery Section, from 2007 to 2016. Results: The authors have noticed a deep relationship between adverse events and cigarette smoking and with pre-operative BMI. Regardless of these variables, the authors focused on the protocol for the management of patients, which required a collaboration between medical and nursing staff. Conclusions: Ex-obese patients have an important risk for complications, but the comparison of our personal data with those of the international literature confirms the efficacy of our management protocol with regard to the prevention of complications. (www.actabiomedica.it)
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The Posterior Arm Flap for Reshaping the Postbariatric Breast. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2434. [PMID: 31942396 PMCID: PMC6908394 DOI: 10.1097/gox.0000000000002434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/12/2019] [Indexed: 01/29/2023]
Abstract
Postbariatric surgery, either by itself or in association with other procedures, tries to correct physical defects and body deformities. Because of the intrinsic complexity of massive weight loss (MWL) patients, more than a single procedure is, most of the time, required. We report a combined surgical method able to improve arms' and breasts' contour that aims to obtain a satisfying functional and aesthetic result by reducing surgical times and costs. Methods A female MWL patient with proper body mass index was clinically evaluated and considered suitable for surgery. While authors performed a modified Pascal-Le Louarn brachioplasty for the upper arm, a standard McKissock mastopexy followed by a Wise pattern skin closure was selected to obtain the breast lift. By sparing the proximal pedicle, the fasciocutaneous flaps were harvested on both posteromedial sides of the arms. The posterior arm flaps (PAF) were tunneled and transposed below the subcutaneous skin bridge across the axilla and finally used to increase the breast mound. Results In the immediate postoperative follow-up, no complications were reported. After the 6-month and 1-year follow-up, both arms' silhouette was documented as healthy and symmetric. Breasts were soft, without any signs of ptosis and/or contracture. No skin disorders or scar hypertrophy or lymphedema were reported. Conclusions PAF in breast contouring procedures is an interesting surgical option, but more patients need to be treated to validate the effectiveness of the procedure. This technique should be considered when there is a need for simultaneously improving arm's contour and breast's volume and shape.
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Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method. J Plast Reconstr Aesthet Surg 2018; 72:649-655. [PMID: 30616907 DOI: 10.1016/j.bjps.2018.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/28/2018] [Accepted: 12/02/2018] [Indexed: 01/08/2023]
Abstract
Body contouring surgery following massive weight loss positively affects a patient's quality of life. However, the procedure is prone to complications. Herein, we stratified complications timewise. Furthermore, we examined whether the weight loss method - bariatric surgery or lifestyle changes - affected the frequency or severity of complications. In this single-centre retrospective analysis, we included 158 patients with massive weight loss undergoing body contouring surgery between 2009 and 2015. We recorded 96 complications in 80 patients, with an overall rate of 51%. Most complications (80.2%) were minor (Clavien-Dindo grades 1 and 2) and superficial wound infections. Immediate complications (0-24 hours post-operation) affected 8.3% of patients, with early complications (1-7 post-operative days) affecting 16.7% of them and late complications (8-30 post-operative days) affecting 58.3% of them. We found no statistical difference in complication rates when comparing bariatric and non-bariatric patients. Older age (p = 0.042) at operation is associated with an increased risk for immediate haematoma or bleeding requiring surgery. Among early complications, a high maximum weight (p = 0.035) and a high preoperative weight (p = 0.0053) significantly correlated with a haematoma or bleeding requiring surgery. For late complications, seroma correlated with older age (p = 0.0061). Complications are primarily minor and non-life threatening after body contouring surgery because of frequent massive weight loss. Here, no particular subgroup of massive weight loss patients appeared more prone to complications. Thus, for each patient, the risks associated with body contouring surgery following massive weight loss should be considered individually.
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A preoperative cotininury test for abdominoplasty reduces peri-operative complications. ANN CHIR PLAST ESTH 2018; 63:307-315. [PMID: 29778249 DOI: 10.1016/j.anplas.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty. MATERIAL AND METHODS This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications. RESULTS Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001). CONCLUSION The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking.
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Theocharidis V, Katsaros I, Sgouromallis E, Serifis N, Boikou V, Tasigiorgos S, Kokosis G, Economopoulos KP. Current evidence on the role of smoking in plastic surgery elective procedures: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:624-636. [PMID: 29426809 DOI: 10.1016/j.bjps.2018.01.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/16/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Smoking is considered to be a significant risk factor for the development of postoperative complications after various surgical procedures, mainly by limiting oxygen delivery to tissues. Evidence on the collective impact of smoking in aesthetic procedure outcomes is scarce. The aim of this study is to evaluate the current evidence on the association between smoking and postoperative outcomes in patients who underwent common elective procedures in plastic surgery. METHODS PubMed and Cochrane bibliographical databases were searched from January 1950 to October 2016 for studies reporting on patients who underwent facelift, abdominoplasty, breast reduction and breast reconstruction and for studies with included data on smoking history of treated patients. RESULTS Fifty-three studies reporting on postoperative complications in tobacco users undergoing facelift, abdominoplasty, breast reduction and reconstruction were identified. Tobacco use is found to significantly increase the total number of postoperative complications as far as abdominoplasty (OR: 5.43; 95% CI = 2.92-10.10), breast reduction (OR: 2.36; 95% CI = 1.64-3.39) and breast reconstruction (OR: 1.91; 95% CI = 1.69-2.17) are concerned. Smoking history does not significantly affect total postoperative complications after facelift procedures (OR: 3.36; 95% CI = 0.92-12.30). CONCLUSIONS Smoking predisposes to surgical site infections, delayed wound healing and skin necrosis in patients undergoing the most common aesthetic procedures in plastic surgery. More rigorous and detailed reporting on the history of tobacco use and surgical outcomes following plastic surgery procedures is needed to better quantify the impact of smoking on the overall postoperative care for this patient population.
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Affiliation(s)
| | - Ioannis Katsaros
- Surgery Working Group, Society of Junior Doctors, 5 Menalou St., Athens, 15123, Greece
| | | | - Nikolaos Serifis
- Surgery Working Group, Society of Junior Doctors, 5 Menalou St., Athens, 15123, Greece
| | - Vasileios Boikou
- Surgery Working Group, Society of Junior Doctors, 5 Menalou St., Athens, 15123, Greece; Department of Marketing and Communication, Athens University of Economics and Business, 76 Patission str., Athens, 10434, Greece
| | - Sotirios Tasigiorgos
- Surgery Working Group, Society of Junior Doctors, 5 Menalou St., Athens, 15123, Greece; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - George Kokosis
- Division of Plastic Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St., Baltimore, MD 21287, USA
| | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, 5 Menalou St., Athens, 15123, Greece; Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
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Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr 2017; 8:382-394. [PMID: 28298280 PMCID: PMC5347111 DOI: 10.3945/an.116.014258] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
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Affiliation(s)
- Shiri Sherf Dagan
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, and
| | - Ariela Goldenshluger
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Globus
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Chaya Schweiger
- The Israel Dietetic Association, Herzliya, Israel
- Herzliya Medical Center, Herzliya, Israel
- Nutrition Service, Rabin Medical Center, Petach Tiqva, Israel; and
| | - Yafit Kessler
- The Israel Dietetic Association, Herzliya, Israel
- The Israeli Center for Bariatric Surgery of Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Galit Kowen Sandbank
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tair Ben-Porat
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tali Sinai
- The Israel Dietetic Association, Herzliya, Israel;
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
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Complications of Lower Body Lift Surgery in Postbariatric Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1030. [PMID: 27757346 PMCID: PMC5055012 DOI: 10.1097/gox.0000000000001030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/22/2016] [Indexed: 12/04/2022]
Abstract
There is an exponential rise of patients with massive weight loss because of bariatric surgery or lifestyle changes. The result is an increase of patients with folds of redundant skin that may cause physical and psychological problems. The lower body lift is a procedure to correct deformities in the abdomen, mons, flanks, lateral thighs, and buttocks. Complication rates are quite high and could negatively affect the positive outcomes. The purpose of this study is to assess complication rates and to identify predictors of complications to optimize outcomes for patients after lower body lift surgery.
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13
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Abstract
BACKGROUND Prevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients. METHODS We searched peer-reviewed articles published between January 1990 and January 2015 in several databases (PubMed, PsycINFO, Cochrane Library, Google Scholar) using different keywords combinations. Studies that focused on pre-surgery substance use only or without reported effect measurements were excluded. RESULTS Overall, 40 studies were included in the review. Preoperative history of substance use was a reliable correlate of postoperative substance use. The prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use than those without. Postoperative prevalence of alcohol use ranged from 7.6% to 11.8%. No significant prevalence change in cigarette smoking from pre-to postoperative period was observed. Time effect was not observed on smoking or drug use prevalence, while an increase in alcohol consumption was inconsistent across studies. The proportion of new-onset substance users among bariatric patients after surgery ranged from 34.3% to 89.5%. CONCLUSION Substance use is associated with poor health among bariatric patients. Preoperative assessment and postoperative follow-up should include interventions to reduce relapse among users and prevent substance use initiation.
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Affiliation(s)
- Linlin Li
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Ellison JM, Steffen KJ, Sarwer DB. Body Contouring After Bariatric Surgery. EUROPEAN EATING DISORDERS REVIEW 2015; 23:479-87. [PMID: 26395601 DOI: 10.1002/erv.2408] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/25/2015] [Indexed: 11/11/2022]
Abstract
Individuals who undergo bariatric surgery generally experience rapid and dramatic weight loss. While the weight loss typically confers significant health benefits, an undesirable consequence is often excessive quantities of hanging, surplus skin. Some patients undergo body-contouring surgery (BCS) in order to improve health, mobility, appearance and psychological adjustment. While the majority of post-bariatric patients desire BCS in one or more body regions, a small percentage of patients receive such surgeries. Lack of knowledge about procedures, cost and (in the USA and several other countries) difficulty obtaining insurance reimbursement likely prevents many patients from undergoing BCS. Those who do undergo BCS appear to be at heightened risk for wound-healing complications. Despite these complications, the majority of patients report satisfactory BCS outcomes. The extant literature in this area provides a great deal of information about these issues; nevertheless, additional research is needed to further inform clinical management and improve patient outcomes.
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Affiliation(s)
- Jo M Ellison
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | | | - David B Sarwer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Pluvy I, Panouillères M, Garrido I, Pauchot J, Saboye J, Chavoin J, Tropet Y, Grolleau J, Chaput B. Smoking and plastic surgery, part II. Clinical implications: A systematic review with meta-analysis. ANN CHIR PLAST ESTH 2015; 60:e15-49. [DOI: 10.1016/j.anplas.2014.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
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Marsh DJ, Fox A, Grobbelaar AO, Chana JS. Abdominoplasty and seroma: A prospective randomised study comparing scalpel and handheld electrocautery dissection. J Plast Reconstr Aesthet Surg 2015; 68:192-6. [DOI: 10.1016/j.bjps.2014.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/16/2014] [Accepted: 10/01/2014] [Indexed: 11/24/2022]
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A Multiple Regression Analysis of Postoperative Complications After Body-Contouring Surgery: a Retrospective Analysis of 205 Patients. Obes Surg 2015; 25:1482-90. [DOI: 10.1007/s11695-014-1559-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Genser L, Tabbara M, Barat M, Carandina S, Bossi M, Rizk N, Polliand C, Quilichini J, Barrat C. Outcomes of Panniculectomy after Bariatric Surgery: A Comparative Study and Review of the Literature. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Laurent Genser
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Malek Tabbara
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Maxime Barat
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Sergio Carandina
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Manuela Bossi
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Nabil Rizk
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Claude Polliand
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Julien Quilichini
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
| | - Christophe Barrat
- Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH “Léonard de Vinci,” AP-HP, Bondy, France
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Gusenoff JA. Prevention and Management of Complications in Body Contouring Surgery. Clin Plast Surg 2014; 41:805-18. [DOI: 10.1016/j.cps.2014.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vongpaisarnsin K, Tansrisawad N, Hoonwijit U, Jongsakul T. Pseudomonas aeruginosa septicemia causes death following liposuction with allogenic fat transfer and gluteal augmentation. Int J Legal Med 2014; 129:815-8. [PMID: 25107297 DOI: 10.1007/s00414-014-1056-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022]
Abstract
Cosmetic surgery to improve aesthetic and body conditions is becoming increasingly popular worldwide. In 2013, the American Society of Plastic Surgeons (ASPS) reported that one of the top five cosmetic procedures in the US is liposuction with over 200,000 procedures per year. This type of surgery is regarded as a minimal risk operation. Since surgical complications are not often reported, liposuction is usually performed in outpatient clinics. Fatality after cosmetic liposuction surgery is also relatively rare. This case report presents a death following cosmetic liposuction with allogenic fat transfer and gluteal augmentation. The medico-legal autopsy, pathology, and postmortem microbiology examinations reveal that septicemia by Pseudomonas aeruginosa was the definite cause of death. Surgical risk assessment and pathogenesis of the organism was reviewed.
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Ducic I, Zakaria HM, Felder JM, Arnspiger S. Abdominoplasty-related nerve injuries: systematic review and treatment options. Aesthet Surg J 2014; 34:284-97. [PMID: 24436448 DOI: 10.1177/1090820x13516341] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Abdominoplasty is a common cosmetic procedure; nerve injury is an underexplored risk of the procedure. OBJECTIVE The authors review existing literature to examine the incidence and treatment of nerve injuries after abdominoplasty procedures and provide a treatment algorithm based on their results. METHODS A search of the literature on MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was undertaken. After full-text review, 23 articles met our criteria. Any mentions of nerve injury, including references to a lack of nerve injury, were documented. All data were pooled for analysis. From our combined data, we calculated the risks of postabdominoplasty nerve injury by dividing the total number of nerve injuries by the total number of patients. RESULTS Pooled data showed that 1.94% of patients sustained specific nerve injury, and 1.02% of patients sustained permanent injury after abdominoplasty. In addition, 7.67% experienced decreased sensation, 1.07% reported chronic pain, and 0.44% reported temporary weakness or paralysis. Nerves directly injured were the lateral femoral cutaneous (1.36% of patients) and iliohypogastric (0.10%) nerves. Nerves injured from surgical positioning were the brachial plexus (0.10%), musculocutaneous (0.10%), radial (0.05%), sciatic (0.19%), and common peroneal (0.05%) nerves. CONCLUSIONS Although our results showed a low incidence of postabdominoplasty nerve injury, the lasting impact on affected patients' quality of life can be significant. Appropriate and timely treatment by a multidisciplinary team is critical to optimize patient outcomes. Better reporting of nerve injuries in future studies of abdominoplasty will provide more accurate information about the incidence and consequences of these injuries. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Ivica Ducic
- Departments of Neurosurgery and Plastic Surgery, Georgetown University Hospital, Washington, DC
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Goertz O, Kapalschinski N, Skorzinski T, Kolbenschlag J, Daigeler A, Hirsch T, Homann HH, Muehlberger T. [Wound healing complications in smokers, non-smokers and after abstinence from smoking]. Chirurg 2014; 83:652-6. [PMID: 22273854 DOI: 10.1007/s00104-011-2230-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pulmonary and cardiovascular ramifications of smoking are well documented and this also applies to increased wound healing complications in smokers. The aim of this study was to ascertain whether preoperatively refraining from smoking would affect the incidence of wound healing disorders. MATERIAL AND METHODS Between 2006 and 2008 a total of 295 patients underwent aesthetic (n = 167) or reconstructive surgery (n = 128). They were divided into three groups: A (n = 98) non-smokers for at least 2 years, B (n = 99) patients who refrained from smoking 6 weeks prior to surgery and C (n = 98) smokers. Smoking abstinence was verified by cotinine tests. Wound healing complications were defined as dehiscent wounds, wound infections, atypical scar formation and adiponecrosis. RESULTS Smokers developed wound healing complications in 48.2% of cases, non-smokers in 21.0% and patients who had stopped smoking for 6 weeks in 30.8% of cases (p = 0.006). CONCLUSION Elective surgery should only be performed on non-smokers and smokers who had refrained from smoking for at least 6 weeks to reduce wound healing complications as far as possible.
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Affiliation(s)
- O Goertz
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum Klinik für Plastische Chirurgie und Handchirurgie, Ruprecht-Karls-Universität Heidelberg, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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van der Beek E, Verveld C, van Ramshorst B, Kon M, Mink van der Molen A. Classification of contour deformities after massive weight loss: The applicability of the Pittsburgh Rating Scale in The Netherlands. J Plast Reconstr Aesthet Surg 2013; 66:1039-44. [PMID: 23668954 DOI: 10.1016/j.bjps.2013.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 02/25/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 760] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 Suppl 1:S1-27. [PMID: 23529939 PMCID: PMC4142593 DOI: 10.1002/oby.20461] [Citation(s) in RCA: 759] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract 2013; 19:337-72. [PMID: 23529351 PMCID: PMC4140628 DOI: 10.4158/ep12437.gl] [Citation(s) in RCA: 285] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9:159-91. [PMID: 23537696 DOI: 10.1016/j.soard.2012.12.010] [Citation(s) in RCA: 445] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 113.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Adams CE, Gabriele JM, Baillie LE, Dubbert PM. Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery. J Behav Health Serv Res 2012; 39:462-71. [PMID: 22374227 DOI: 10.1007/s11414-012-9277-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although evaluations of tobacco and substance use disorders (SUDs) are required before bariatric surgery, the impact of these factors on postsurgical outcomes is unclear. This study describes (1) the prevalence of tobacco and SUDs in 61 veterans undergoing bariatric surgery, (2) associations between presurgical tobacco use and postsurgical weight loss, and (3) relationships between presurgical SUDs and postsurgical weight loss. Height, weight, tobacco, and SUDs were assessed from medical charts at presurgery and 6, 12, and 24 months postsurgery. Thirty-three patients (55%) were former or recent tobacco users; eight (13%) had history of SUDs. All patients who quit smoking within 6 months before surgery resumed after surgery, which was associated with increased weight loss at 6 and 12 months. Presurgical SUDs were related to marginally worse weight loss at 12 and 24 months. Bariatric surgery candidates with history of smoking and/or SUDs might benefit from additional services to improve postsurgical outcomes.
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Affiliation(s)
- Claire E Adams
- Department of Health Disparities Research-Unit 1440, University of Texas MD Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402, USA.
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Gravante G, Elmussareh M. Enhanced recovery for non-colorectal surgery. World J Gastroenterol 2012; 18:205-11. [PMID: 22294823 PMCID: PMC3261537 DOI: 10.3748/wjg.v18.i3.205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023] Open
Abstract
In recent years the advent of programs for enhanced recovery after major surgery (ERAS) has led to modifications of long-standing and well-established perioperative treatments. These programs are used to target factors that have been shown to delay postoperative recovery (pain, gut dysfunction, immobility) and combine a series of interventions to reduce perioperative stress and organ dysfunction. With due differences, the programs of enhanced recovery are generally based on the preoperative amelioration of the patient’s clinical conditions with whom they present for the operation, on the intraoperative and postoperative avoidance of medications that could slow the resumption of physiological activities, and on the promotion of positive habits in the early postoperative period. Most of the studies were conducted on elective patients undergoing colorectal procedures (either laparotomic or laparoscopic surgery). Results showed that ERAS protocols significantly improved the lung function and reduced the time to resumption of oral diet, mobilization and passage of stool, hospital stay and return to normal activities. ERAS’ acceptance is spreading quickly among major centers, as well as district hospitals. With this in mind, is there also a role for ERAS in non-colorectal operations?
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Araco A, Gravante G, Gentile P, Cervelli V. Surgical site infections after post-bariatric abdominoplasty and flank liposuction: a case-control study focusing on the quantity of tissue removed. Surg Today 2012; 42:97-99. [PMID: 22139088 DOI: 10.1007/s00595-011-0076-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 07/24/2009] [Indexed: 01/07/2023]
Abstract
We evaluated whether the quantity of fat removed during abdominoplasty and liposuction correlated with the occurrence of surgical site infection (SSI). We selected patients of similar age, sex, smoking status, obesity, and post-bariatric weight loss, retrospectively, and classified them into groups according to the development of SSI. The total amount of fat removed and aspirated was compared. The size of the flap removed from the abdomen and the amount of fat aspirated with liposuction differed significantly between the SSI and no-SSI groups (1.6 ± 0.2 vs. 0.6 ± 0.3 kg and 2 ± 0.2 vs. 0.9 ± 0.3 l, respectively; p < 0.001). The four SSI patients with the most fat removed (1.4 ± 0.2 kg) or aspirated (2 ± 0.1 l kg) had the deepest infections. SSI was strongly correlated with the size of flap resection (ρ = 0.80; p < 0.001) and liposuction (ρ = 0.72; p < 0.001). The quantity of fat removed or aspirated can influence the occurrence of SSI. If confirmed, these data could be used to better stratify patients according to their risk.
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Affiliation(s)
- Antonino Araco
- Department of Plastic Surgery, University of Tor Vergata, Rome, Italy
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Abstract
Indications for most forms of abdominoplasty are slight weight fluctuations or pregnancy. The steadily increasing number of patients with greater weight loss as well as the growing number of bariatric operations subsequently leads to a significant increase in body contouring procedures and places new challenges on plastic surgeons. After major weight loss patients present with extremely variable deformities in the lower and upper trunk as well as the extremities, which have to be treated individually with an appropriate procedure. The restoration of the lower trunk presents the first stage of the entire reconstruction process. The various modifications of abdominoplasty procedures with their various incision patterns and scar courses and the circumferential lower trunk dermatolipectomy represent advanced operations for every individual case. Plastic surgeons should be fully aware of differences and indications of every available procedure in the area of the lower trunk and should have the ability to offer the entire repertory for each individual deformity. A high postoperative patient satisfaction results from a customized procedure selection, the optimal implementation with a correspondingly low rate of complications and above-average patient care.
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Affiliation(s)
- D F Richter
- Klinik für Plastische Chirurgie, Dreifaltigkeits-Krankenhaus, Wesseling, Deutschland.
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van der Beek ES, van der Molen AM, van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal. Obes Facts 2011; 4:61-6. [PMID: 21372612 PMCID: PMC6444757 DOI: 10.1159/000324567] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Body contouring surgery is in high demand following the increase in bariatric surgery. Massive weight loss leads to an excess of lax, overstretched skin causing physical and psychosocial discomfort. Plastic surgical procedures can give rise to an improvement in quality of life, but the relative high complication rate could negatively affect these potential gains. The purpose of this study is to identify predictors of complications in order to optimize outcomes in this patient population. METHODS Out of a group of 465 post-bariatric patients, 61 patients underwent body contouring surgery following massive weight loss. A total of 43 respondents were reviewed retrospectively for demographic data, pre- and post-operative weight status and co-morbidities. Medical complications were categorized according to the modified Clavien classification. All cases were analyzed for risk factors. RESULTS A stable weight over a period of at least 3 months prior to body contouring surgery is associated with a significant lower complication rate (odds ratio 0.24; CI 0.07-0.79) and the percentage excess weight loss (odds ratio 0.96; 95% CI 0.92-1.00) was an independent predictor for the occurrence of complications. The overall complication rate was 27.9% with a major complication rate of 8.8%. Most frequent procedures were abdominoplasty (61%) and breast reduction/ mammapexy (25%). CONCLUSION This study emphasizes the importance to strive for a stable weight close to normal before surgery to minimize the risk of complications. The positive effects of the long-term results of bariatric surgery tolerate the relative high complications rate. Careful pre-operative planning and patient selection are essential to optimize the results of body contouring surgery of post-bariatric patients.
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Affiliation(s)
| | - Aebele Mink van der Molen
- Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Nieuwegein
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- *Bert van Ramshorst MD, PhD, Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands, Tel +31 30 60-99111, Fax +-36578,
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Postbariatric patients undergoing body-contouring abdominoplasty: two techniques to raise the flap and their influence on postoperative complications. Ann Plast Surg 2009; 62:613-7. [PMID: 19461270 DOI: 10.1097/sap.0b013e3181856d85] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Postbariatric patients undergoing abdominoplasties were retrospectively analyzed to correlate postoperative local complications with the 2 most commonly used techniques of raising the abdominal flap: diathermocoagulation versus scalpel. All patients undergoing body-contouring abdominoplasties were included. Excluded were patients with ongoing clinical infections, those that received a complete course of antibiotic in the 6 months before operation, those requesting steroid therapy, those with systemic diseases that could impair wound repair (arteriosclerosis, diabetes mellitus), and those who had undergone apronectomy. One hundred thirty-seven patients were divided into 2 groups (diathermocoagulation = 90 vs. scalpel = 47). Overall, 7 seromas (5.1%), 7 hematomas (5.1%), and 28 wound infections (20.4%) were detected. A higher occurrence of postoperative hematomas was found after the flap raised using a scalpel (12.8% vs. 1.1%, Fisher exact test, P < 0.05), with a relative risk of 11.6. A significant association existed between postoperative hematomas and wound infections with delayed healing (n = 10, 7.3%): 43% of patients with a hematoma also experienced a wound infection with delayed healing versus 5.4% of those that did not develop hematomas (Fisher exact test; P < 0.01). In patients for whom a scalpel had been used to raise the flap, this correlation persisted (50% of patients with a hematoma had developed a wound infection with delayed healing vs. 7.3% of those that did not develop hematomas; Fisher exact test; P < 0.05).In postbariatric patients, diathermocoagulation reduces the occurrence of postoperative hematomas and wound infections with delayed healing compared with the cold knife.
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Araco A, Araco F, Abdullah P, Overton J, Gravante G. Pseudomonas aeruginosa necrotizing infection of the abdominal flap in a post-bariatric patient undergoing body contouring surgery. Obes Surg 2008; 19:812-6. [PMID: 18953619 DOI: 10.1007/s11695-008-9730-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
Pseudomonas aeruginosa infections may involve any organ or body district and may give serious clinical sequelae. We report the case of an infection of the abdominoplasty flap that compromised wound closure and jeopardized the aesthetic outcome. To the best of our knowledge, this is the first such case reported in the literature for this group of patients. We have presented this case in order to alert plastic and general surgeons who may encounter this complication in future, such that they may be aware of the need to adopt an aggressive approach to manage these patients. This consisted of the accurate monitoring of the patient's clinical condition, prescribing appropriate antibiotics, and performing serial debridement of necrotic tissue.
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Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis. Obes Surg 2008; 19:553-9. [PMID: 18751762 DOI: 10.1007/s11695-008-9659-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 08/04/2008] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study analyzed the impact of weight reduction method, preoperative, and intraoperative variables on the outcome of reconstructive body contouring surgery following massive weight reduction. METHODS All patients presenting with a maximal BMI >/=35 kg/m(2) before weight reduction who underwent body contouring surgery of the trunk following massive weight loss (excess body mass index loss (EBMIL) >/= 30%) between January 2002 and June 2007 were retrospectively analyzed. Incomplete records or follow-up led to exclusion. Statistical analysis focused on weight reduction method and pre-, intra-, and postoperative risk factors. The outcome was compared to current literature results. RESULTS A total of 104 patients were included (87 female and 17 male; mean age 47.9 years). Massive weight reduction was achieved through bariatric surgery in 62 patients (59.6%) and dietetically in 42 patients (40.4%). Dietetically achieved excess body mass index loss (EBMIL) was 94.20% and in this cohort higher than surgically induced reduction EBMIL 80.80% (p < 0.01). Bariatric surgery did not present increased risks for complications for the secondary body contouring procedures. The observed complications (26.9%) were analyzed for risk factors. Total tissue resection weight was a significant risk factor (p < 0.05). Preoperative BMI had an impact on infections (p < 0.05). No impact on the postoperative outcome was detected in EBMIL, maximal BMI, smoking, hemoglobin, blood loss, body contouring technique or operation time. Corrective procedures were performed in 11 patients (10.6%). The results were compared to recent data. CONCLUSION Bariatric surgery does not increase risks for complications in subsequent body contouring procedures when compared to massive dietetic weight reduction.
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Iljin A, Szymanski D, Kruk-Jeromin J, Strzelczyk J. The repair of incisional hernia following Roux-en-Y gastric bypass-with or without concomitant abdominoplasty? Obes Surg 2008; 18:1387-91. [PMID: 18368458 DOI: 10.1007/s11695-008-9488-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 02/29/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND Incisional hernia, found in up to 25% of patients, is a typical complication of open bariatric surgery. METHODS Open Roux-en-Y gastric bypass (RYGB) was performed in 204 patients. They have been followed-up for at least 6 months. Thirty-two patients in whom incisional hernia was diagnosed were divided into two groups-they were scheduled for hernia repair or hernia repair with abdominoplasty. The surgery was performed, on average, 20 months after RYGB operation. Fourteen patients [mean body mass 86.4 kg, mean body mass index (BMI) 30.0 kg/m(2)] have had hernias repaired. The mean duration of hospital stay was 7.2 days. Hernia repair along with abdominoplasty was performed in 18 patients with mean body mass 89.4 kg and BMI 31.5 kg/m(2). The mean duration of hospital stay was 8.7 days. RESULTS Both examined groups were similar in body mass, BMI, age, and duration of hospital stay (p > 0.05), as well as gender distribution. The wound infection was diagnosed in six patients. CONCLUSION The simultaneous abdominoplasty does not prolong the time of hospital stay of the patients undergoing incisional hernia repair. Infection is the most frequent complication of incisional hernia repair.
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Affiliation(s)
- A Iljin
- Department of Plastic Surgery, Barlicki Hospital, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
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