Post-bariatric reconstructive surgery

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The term post-bariatric reconstructive surgery (also post-bariatric plastic surgery ; etymology: Latin post- 'after'; ancient Greek : βάρος baros 'weight', 'heaviness', 'load', βαρύς barys 'heavy weight', ίατρός iatros 'doctor') denotes operative measures for the restoration and functional reconstruction of the body silhouette after massive weight reduction. The term restore operation is also used frequently.

The medical specialties of Bariatric and the bariatric surgery deal with overweight and obesity .

Operations

The most common procedure is the tummy tuck (abdominoplasty) with umbilical reimplantation, followed by upper arm, thigh and breast lifts ( mastopexy ). Circular lifts are performed as a belt lipectomy or as a Lockwood body lift operation , optionally combined with a thigh lift . The possible complications of the interventions such as rebleeding, seroma formation and wound healing disorders are observed with a frequency of 10–20% and may require repeated operations and a correspondingly longer follow-up treatment. In addition to dermolipectomy , post-bariatric patients often have a complex reconstruction of the subcutaneous fascia (Scaper's fascia ) and possibly the muscle fascia in order to achieve a long-term stable result.

Medical indication and reimbursement

The interventions (dermolipectomy) are medically indicated and are therefore clearly differentiated from aesthetic surgery . Very often, weight loss has been achieved with the help of bariatric surgery. In most cases the weight reduction is 50–100 kg, in rare cases more than 200 kg. This results in massive excess skin on the entire trunk as well as on the thighs and upper arms. For many patients, the restoration of the body silhouette is the "end point" after massive weight reduction and thus the treatment goal of permanent weight reduction and sustainable lifestyle changes .

For the first time, the current guideline on obesity surgery has taken into account post-bariatric corrective interventions. It should be noted, however, that unrealistic expectations of the patient can lead to subjectively disappointing results.

As a rule, elective interventions can be planned, so that prior to the operation, the health insurance company has to obtain a commitment on the basis of a decision on a case-by-case basis. The application is submitted by the patient and the treating clinic in the form of an expert opinion. Objective findings, such as extensive skin-to-skin contact zones with irritation and navel depth, or functional limitations (e.g. when using the toilet), are recorded and photo-documented. In addition, there are statements or treatment reports from specialists such as dermatologists and orthopedic surgeons , and an opinion from a psychologist may also be obtained. The statutory health insurance will base its decision largely on the expert opinion of the medical service (MDK). It is also important to what extent the expected weight reduction has come to a standstill after an obesity surgery and whether the desired weight goal (target weight) has been achieved. There is usually a year or two between obesity surgery and the first reconstructive surgery. In a very large number of cases, there is initially no promise of costs, but the option then remains to lodge an objection, to file a lawsuit at the social court or to file the application again later . In Austria, the costs of reconstructive surgery after obesity surgery are generally covered by the statutory health insurance companies.

photos

  • Condition of a patient after weight loss before surgery

  • Condition of a patient after weight loss before surgery

  • Fat apron resection

  • After sleeve stomach and weight reduction of about 70 kg before the operation

  • Resectate (approx. 20 kg) of a lipedema

literature

  • B. Strauch, CK Herman: Encyclopedia of Body Sculpting after Massive Weight Loss. Thieme, New York / Stuttgart 2010, pp. 71, 79-89, ISBN 978-1-60406-246-5

Individual evidence

  1. ↑ Ludwig August Kraus: "Kritisch-etymologisches medicinisches Lexikon", 3rd edition, Verlag der Deuerlich- und Dieterichschen Buchhandlung, Göttingen 1844, p. 154.
  2. ↑ Compare also according to Ludwig August Kraus (page 155) with stretcher and shelf as well as with English (also Persian) burden = load, burden, burden, loading.
  3. ↑ A. Dragu, U. Kneser, RE Horch: Post-bariatric plastic surgery and its special challenges , 129th Congress of the German Society for Surgery , 24. – 27. April 2012, Berlin (abstract online )
  4. ^ A b T. C. Werner: Postbariatric reconstructive surgery in the light of the new law on patient rights . CHAZ 14 (4), 2013, 281-282
  5. ↑ a b c P. E. Hüttl, TP Hüttl: Legal issues of bariatric surgery: Legal problems of a "new" operative measure , ( online ( memento of the original from 23 September 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this note. ) @1@ 2Template: Webachiv / IABot / www.bdc.de
  6. ↑ a b c d D. F. Richter, A. Substance: Body tightening. From the abdominal wall plasty to the body lift . The Surgeon , 82, 2011, 797-806
  7. ↑ a b c U. E. Ziegler: Plastic combination interventions after massive weight loss . CHAZ 11 + 12, 2010, 631-638
  8. ↑ a b c M. Büsing: Plastic surgery as an integral part of the obesity center . 6th Obesity Symposium 2013, Norderstedt 21. – 22. February 2013.
  9. ↑ Fischborn et al.
  10. ↑ a b A. Dragu, RE Horch: The reconstruction of the body shape after massive weight reduction . CHAZ 11 + 12, 2012, 601–607
  11. ↑ a b c H. Kitzinger, S. Abayev, A. Pittermann et al .: After Massive Weight Loss: Patient Expectations of Body Contouring Surgery. In: Obesity Surgery . 22 (4), 2012, 544-548
  12. ↑ a b AWMF guideline (S3 - valid until June 1, 2015): Surgery of obesity ( online )