What Plastic Surgeons Should Know about Bariatric Surgery

ABSTRACT

Bariatric surgery is the current standard treatment for severe obesity. A variety of procedures are currently performed, which provide durable and rapid weight loss through malabsorption, restriction, or a combination of the two. The significant amelioration of obesity-associated comorbidities has been demonstrated. Laparoscopic techniques in bariatric surgery provide patients with decreased morbidity and faster recovery, with an equivalent amount of weight loss. Weight loss is dramatic and progressive until a plateau is reached. Patients often seek the services of a plastic surgeon to remove the excess lax skin and improve the ptosis associated with such massive weight loss.

KEYWORDS

Morbid obesity - bariatric surgery - adjustable gastric band - biliopancreatic diversion - gastric bypass

REFERENCES

• 1 Livingston E H. Procedure incidence and in-hospital complication rates of bariatric surgery in the United States.  Am J Surg. 2004;  188 105-110
• 2 Brolin R E. Update: NIH consensus conference. Gastrointestinal surgery for severe obesity.  Nutrition. 1996;  12 403-404
• 3 National Institutes of Health .The practical guide: identification, evaluation and treatment of overweight and obesity in adults. June 17, 1998 Available at: http://www.nhlbi.nih.gov/guidelines/obesity/practgde.htm Accessed December 20, 2005
• 4 Nguyen N T, Goldman C, Rosenquist C J et al.. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.  Ann Surg. 2001;  234 279-291
• 5 Schauer P R, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic roux-en-Y gastric bypass for morbid obesity.  Ann Surg. 2000;  232 515-529
• 6 Nguyen N T, Lee S L, Goldman C et al.. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial.  J Am Coll Surg. 2001;  192 469-476
• 7 Balsiger B M, Poggio J L, Mai J, Kelly K A, Sarr M G. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity.  J Gastrointest Surg. 2000;  4 598-605
• 8 Nightengale M L, Sarr M G, Kelly K A, Jensen M D, Zinsmeister A R, Palumbo P J. Prospective evaluation of vertical banded gastroplasty as the primary operation for morbid obesity.  Mayo Clin Proc. 1991;  66 773-782
• 9 Fielding G A, Ren C J. Laparoscopic adjustable gastric band.  Surg Clin North Am. 2005;  85 129-140
• 10 DeMaria E J. Laparoscopic adjustable silicone gastric banding: complications.  J Laparoendosc Adv Surg Tech A. 2003;  13 271-277
• 11 Biertho L, Steffen R, Ricklin T et al.. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases.  J Am Coll Surg. 2003;  197 536-544
• 12 Weber M, Müller M K, Bucher T et al.. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity.  Ann Surg. 2004;  240 975-982
• 13 Scopinaro N, Adami G F, Marinari G M et al.. Biliopancreatic diversion.  World J Surg. 1998;  22 936-946
• 14 Marceau P, Hould F-S, Simard S et al.. Biliopancreatic diversion with a duodenal switch.  World J Surg. 1998;  22 947-954
• 15 Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch.  Surg Clin North Am. 2005;  85 141-149
• 16 Deveney C W, MacCabee D, Marlink K et al.. Roux-en-Y divided gastric bypass results in the same weight loss as duodenal switch for morbid obesity.  Am J Surg. 2004;  187 655-659
• 17 DeMaria E J. Is gastric bypass superior for the surgical treatment of obesity compared with malabsorptive procedures?.  J Gastrointest Surg. 2004;  8 401-403
• 18 Herron D M. Biliopancreatic diversion with duodenal switch vs. gastric bypass for severe obesity.  J Gastrointest Surg. 2004;  8 406-407
• 19 Schauer P R, Ikramuddin S, Hamad G et al.. Laparoscopic gastric bypass surgery: current technique.  J Laparoendosc Adv Surg Tech A. 2003;  13 229-239
• 20 Brolin R E. Gastric bypass.  Surg Clin North Am. 2001;  81 1077-1095
• 21 Higa K D, Boone K B, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients-what have we learned?.  Obes Surg. 2000;  10 509-513
• 22 Schwartz M L, Drew R L, Roiger R W, Ketover S R, Chazin-Caldie M. Stenosis of the gastroenterostomy after laparoscopic gastric bypass.  Obes Surg. 2004;  14 484-491
• 23 Nguyen N T, Stevens C M, Wolfe B M. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass.  J Gastrointest Surg. 2003;  7 997-1003
• 24 Garza E, Kuhn J, Arnold D, Nicholson W, Reddy S, McCarty T. Internal hernias after laparoscopic Roux-en-Y gastric bypass.  Am J Surg. 2004;  188 796-800
• 25 Stocker D J. Management of the bariatric surgery patient.  Endocrinol Metab Clin North Am. 2003;  32 437-457
• 26 Sugerman H J, Brewer W H, Shiffman M L et al.. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss.  Am J Surg. 1995;  169 91-96
• 27 Wittgrove A C, Clark G W. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3-60 month follow-up.  Obes Surg. 2000;  10 233-239
• 28 Schauer P R, Burguera B, Ikramuddin S et al.. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.  Ann Surg. 2003;  238 467-483
• 29 Sugerman H J, Wolfe L G, Sica D A, Clore J N. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss.  Ann Surg. 2003;  237 751-756
• 30 Pories W J, Swanson M S, MacDonald K G et al.. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.  Ann Surg. 1995;  222 339-350
• 31 MacDonald K G, Long S D, Swanson M S et al.. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus.  J Gastrointest Surg. 1997;  1 213-220
• 32 Dhabuwala A, Cannan R J, Stubbs R S. Improvement in co-morbidities following weight loss from gastric bypass surgery.  Obes Surg. 2000;  10 428-435
• 33 Sacks J, Sterry T P. Plastic surgery after excessive weight loss. In: Inabnet WB, DeMaria EJ, Ikramuddin S Laparoscopic Bariatric Surgery. Philadelphia, PA; Lippincott Williams & Wilkins 2005: 314-324
• 34 Acarturk T O, Wachtman G, Heil B et al.. Panniculectomy as an adjuvant to bariatric surgery.  Ann Plast Surg. 2004;  53 360-366
• 35 Knoetgen J, Petty P M, Johnson C H. Plastic surgery after bariatric surgery and massive weight loss.  Mayo Clin Proc. 2005;  80 136