Postbariatric surgery helps patients after extensive weight loss

Obese patients who have lost a lot of weight due to obesity therapy or surgery, like sleeve gastrectomy or gastric bypass, often have problems with lappets. Postbariatric operations is important for patients to get rid of excessive lappets at abdomen, arms and legs.

(Photo: IFB Adipositas)

The patients  suffer from these lappets psychologically and physically. Postbariatric reconstructive surgery can help alleviate this. The University Hospital Leipzig offers both, bariatric and postbariatric surgical methods. At the recent meeting of junior researchers in the  “Science Lunch” of the IFB AdiposityDiseases Dr. Jeannine Sauber (Department for Surgery, University Hospital Leipzig) discussed medical and psychological aspects of postrabriatric surgery together with scientists and physicians.

However, preliminary to a postbariatric procedure the patients have to comply with some requirements. They have to have reached a stable target weight that has been kept during at least six months and the body mass index should be under 30 kg/sqm. This target value is mostly reached within two years after the bariatric surgery. Moreover, the patients should be psychicologically balanced. 

In Germany, the assumption of the costs for the postbariatric surgery has to be requested at the individual health insurer by the attending physician. Whether the insurance meets the costs depends especially on the individual health status of the patient. It comes e. g.  to increased sweating and irritations under the skin folds hence dermatophytes and eczemas occur frequently. Despite careful body hygiene those ailments are only treatable by surgically removing and tightening of the excessive skin areas.

The large skin lappets also lead to constraints in the mobility of the patient. Furthermore, the psychological and psychosocial rehabilitation of bariatric patients is crucial and thus also postbariatric surgery. Often only a postbariatric intervention allows the patients unimpeded movement and normal clothes. That is why postbariatric surgery dissociates itself clearly from the so-called “cosmetic surgery” and its mere aesthetic goals.

If all requirements for an ntervention are met, initially a comprehensive examination and specific consultation of the patient follow. According to scope and position of the excessive skin lappets the number of interventions is being determined and the affected area is being marked in a standing upright position of the patient. A simple liposuction is mostly due to the bulk of excessive skin not possible, because the tissue concerned could not tighten by itself. Since often other body areas like upper arms, thighs, breasts or the butt are affected next to the belly, specialized surgeons do the body streamlining in several interventions in intervals of about six months.

Within the tummy tuck excessive skin at the lower end is been removed. The remaining skin areas are subsequently sutured. A transposition of the bellybutton may be necessary, if it is located in the removed tissue. Drainages improve the tissue healing process after the surgery, because they ensure an optimal drainage of blood and ichor. Due to the increased skin tension after the operation the patient initially has to release pressure from the area affected and has to be in compressing dressing for at least six weeks. The patient receives a suporting psychological therapy if needed. He or she has to renounce physical activities that can burden the operation area during about four months. After about six months and an optimal healing process, further interventions can be carried out.

The quality of living and the psychological well-being improves a lot due to postbariatric surgery. Yet, it has to be clear even after the complete healing process the ideal image of a healthy normal-weight person cannot completely be achieved. With the help of physicians and therapists patients should develop an expectation as realistic as possible. It is also important to keep the individual level and process of the obesity in mind to avoid disappointment. In cases of severe obesity the results even after postbariatric surgery may otherweise be dissapointing.

Martin Liborak