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.
Highlights
Surgical procedures for treatment of severe obesity and obesityrelated comorbidities have been integrated as part of public as well as private health care during the last two decades
The aim of this study was to explore the role of abdominoplasty on weight development from the time of maximum weight loss until 5 years after roux-en-Y gastric bypass (RYGB), in a population who had access to abdominoplasty 2 years after surgery if they reached a nadir body mass index (BMI) of
From a total of 645 patients, 483 (75%) women, and 162 (25%) men, information on nadir BMI was available in 633 patients (98.1%), and BMI 5 years after Roux-en-Y gastric bypass (RYGB) was available in 553 patients (85.7%)
Summary
Surgical procedures for treatment of severe obesity and obesityrelated comorbidities have been integrated as part of public as well as private health care during the last two decades. More than half a million people have bariatric surgery every year, and most of them experience considerable weight loss during the first years after surgery [1, 2]. Secondary WR after bariatric surgery might be regarded as a failure of the surgical method or as a natural progression of the chronic disease of obesity. Many factors may contribute to the secondary WR, and the patients’ motivation for lifelong changes in diet and habits of physical activity has been regarded as the main factor for weight loss maintenance after bariatric surgery. The knowledge on the biological mechanism beyond voluntary control of secondary WR after bariatric surgery is increasing [4]
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