POST-BARIATRIC SURGERY / POST-OBESITY SURGERY

Obesity has become a public health problem in many countries around the world. Many people suffer from diseases associated with obesity (arterial hypertension, diabetes, heart attack, hyperlipidemias, respiratory insufficiency, and musculoskeletal diseases from overload on the hips and knees).

To address this serious problem, health systems have been supporting technology and science in the search for medical and/or surgical solutions — all within an interdisciplinary management framework accompanied by different specialties.

Obesity groups have been formed where, after appropriately selecting patients, they are integrated into medical and/or surgical management with clear weight-reduction objectives.

As a result of massive weight loss, severe excess skin appears on the body contour with serious functional and aesthetic problems that deserve timely attention.

For this reason, some Plastic Surgeons have integrated into these interdisciplinary groups to offer solutions to this problem.

It is important to emphasize that massive weight loss produces significant metabolic changes that alter the general condition of patients. Hence the importance of management by an interdisciplinary medical-surgical team with experience, in a tertiary-level clinical center, which collaborates in reducing the risk of complications and achieving good results.

Surgical Technique

The surgical trauma and inflammatory response in patients with massive weight loss undergoing Post-Bariatric Surgery are different due to metabolic disorders from nutritional deficiencies that can compromise their general condition and recovery processes. This obliges us to be prudent and to carry out each of these surgical events step by step with rigorous protocols.

The skin trimming procedures and improvements in tissue position and shape are based on the same principles and concepts used in Aesthetic Plastic Surgery for Abdominoplasty or Abdominal Lipectomy and Mammoplasty and/or Mastopexy.

Other areas such as the anterior, lateral, and posterior chest and axillary region (Thoracoplasty), posterior waist (Posterior Dermolipectomy), arms (Brachioplasty), and inner thighs (Cruroplasty or Thigh Lift or Thigh Dermolipectomy) require special surgical techniques.

I emphasize that abdominal skin excess is frequently accompanied by excess skin in the posterior waist.

To correct this circular excess skin, a Torsoplasty is required.

This procedure requires more surgical time than a regular Abdominoplasty, and for this reason I recommend in some patients performing it in two different surgical stages.

I must remember that prolonged surgical times increase the risk of complications and compromise the health of patients.

Liposuction can be a good complement in some selected cases to improve the shape and proportions of the different anatomical units of the body contour.

Approximate surgical times are:

• Abdominoplasty: 2–3 hours.
• Torsoplasty: 4–5 hours.
• Mammoplasty: 2–3 hours.
• Brachioplasty: 2 hours.
• Cruroplasty or thigh lift: 2–3 hours.
• Thoracoplasty: 2–4 hours.

General anesthesia.

24 hours of hospitalization.

Pre-Surgical Examinations

The rigor in analyzing and approving pre-surgical examination results is high. This is because patients with massive weight loss are frequently anemic and have alterations in other laboratory tests.

We must consider the following laboratory tests:

1. Complete blood count: Low hemoglobin levels (anemias) are common due to vitamin and iron deficiencies.
2. Coagulation Tests: Prothrombin Time and Thromboplastin Time.
3. Blood Chemistry: Blood glucose, glycosylated hemoglobin, Total Proteins, Albumin (for nutritional deficiencies), Creatinine, Blood Urea Nitrogen, Ferritin, Zinc, Vitamin B12, etc.
4. Thyroid Tests: TSH, free T4.
5. Urinalysis.

Complications

It is well known that the risk of complications increases with multiple surgical procedures and prolonged surgical times. For this reason, I refrain from combining surgeries and scheduling procedures lasting more than 4–5 hours.

Some of the risks include:

1. Bleeding, hematomas, or seromas.

It must be emphasized that the risk of post-surgical anemia is higher and therefore the possibility of blood transfusions is greater.

1. Infections.
2. Altered sensitivity in the surgical area.
3. Poor scarring.
4. Skin necrosis.
5. Deep Vein Thrombosis.

The risk of deep vein thrombosis obliges us to take precautionary measures using vascular compressors during and immediately after surgery on the lower limbs, and occasionally pharmacological prophylaxis with low molecular weight heparins.

Recovery

Work and social activities restricted for 2 to 3 weeks.

Sports activities restricted for 4 to 6 weeks.

It is important to note that recovery time involves factors such as the patient's personality, pain threshold, skin type, and physical constitution, among others.