Reply

Abstract

Sir: We would like to thank Seretis et al. for their thoughtful, systematic review in response to our article and would like to take this opportunity to make a few comments. Out primary goal was to highlight the interesting fact that 70 percent of our patients reported increased satiety, a finding that, to our knowledge, had not yet been reported or explored. It is our belief that satiety is a major contributing factor to long-term weight loss in our patients under study. We would like to clarify that we do not believe or intend to imply that the weight loss that was observed in our patients was simply the effect of removing adipose tissue. The systematic review by Seretis et al. focuses primarily on studies with lipectomy alone. Eight of the 11 studies included in their review were of either conventional liposuction or large-volume liposuction. Of the three studies in which abdominoplasty was performed, only one (by Swanson) used abdominal plication.1–3 In that single study, abdominoplasty patients were combined with patients undergoing liposuction for analysis, obscuring the results. Furthermore, the long-term weight gain reported by Rinomhota et al. was not significantly different from the weight gained by the control group, making it difficult to attribute weight gain to the abdominoplasty without plication.2 In addition, patients in the study by Mohammed et al. with long-term follow-up were called at least once per week and reminded not to make any changes to their food intake, physical activity level, or weight.4 This instruction may have influenced their finding of no long-term change in weight. In contrast, our patients were encouraged to adopt a healthy diet and exercise. Although the systematic review by Seretis et al. does not help us to draw conclusions regarding the efficacy of abdominoplasty with abdominal corseting on weight loss, it does help shed light on the fact that lipectomy alone is unlikely to be the primary cause of satiety and weight loss in our patients. The question then remains regarding the cause of this increased satiety. The regulation of appetite is a complex interaction of endocrine and neurally mediated mechanisms. Our patients underwent a tight musculofascial plication of the rectus abdominis using a two-layered permanent suture in addition to the removal of their excess abdominal skin and adipose. The extent of tightening of the abdominal wall in patients with a body mass index greater than 24.5kg/m2 was uniformly greater than for patients with a lower body mass index. Corseting of the abdominal wall musculature is associated with an increase in intraabdominal pressure.5–8 Similarly, gastric banding and sleeve gastrectomies are associated with a prolonged decrease in appetite.9 Larger and prospective studies are indeed needed to affirm the findings of our pilot study and to help answer the fundamental question of what the key mechanisms of satiety are. Jennifer C. Fuller, B.A. University of California, Los Angeles, School of Medicine Los Angeles, Calif. Catherine Nguyen, B.A. Tulane School of Medicine New Orleans, La. Rex Edward Moulton-Barrett, M.B.Ch.B. Alameda Hospital Alameda, Calif.