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Pérez Pico AM, Gómez González MÁ, Alarcón González MI, Villar Rodríguez J, Mayordomo Acevedo R. Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass. Obes Surg 2023; 33:3829-3840. [PMID: 37816972 PMCID: PMC10687121 DOI: 10.1007/s11695-023-06843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Obesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery. MATERIALS AND METHODS We conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12-18 months after surgery in 11 of them. RESULTS We observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium. CONCLUSION Weight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.
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Affiliation(s)
- Ana María Pérez Pico
- DEDAP Research Group, Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain
| | - María Ángeles Gómez González
- DEDAP Research Group, Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain
- DEDAP Research Group, Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura. Prevention Unit, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain
| | | | - Julia Villar Rodríguez
- DEDAP Research Group, Department of Anatomy, Cell Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain
| | - Raquel Mayordomo Acevedo
- DEDAP Research Group, Department of Anatomy, Cell Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain.
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Sinik LM, Elver AA, Egan KG, Johnson BM, Cullom ME, Limpiado M, Nazir N, Lai EC, Butterworth JA. Autologous Breast Reconstruction after Massive Weight Loss: Understanding Risks in a Growing Population. Plast Reconstr Surg 2023; 152:503-512. [PMID: 36827470 DOI: 10.1097/prs.0000000000010318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rising rates of obesity and bariatric surgery, more patients who have experienced MWL will be presenting for breast reconstruction. The authors hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared with reconstruction in patients without a history of MWL. METHODS A retrospective review was performed on patients who underwent autologous breast reconstruction by five microsurgeons at an academic institution from 2009 through 2020. Patients with a history of bariatric surgery or greater than 50-pound weight loss were identified and compared with patients who had not experienced MWL. Analysis compared demographics, operative details, complications, revision rates, and BREAST-Q scores. RESULTS Of 916 patients who underwent 1465 flaps, 39 patients with MWL (4.3%) underwent 68 flaps (4.6%), and 877 patients without MWL underwent 1397 flaps. MWL patients were more likely to require blood transfusions postoperatively ( P = 0.005); experienced more surgical-site infections ( P = 0.02), wound-healing complications of flap ( P = 0.007) and donor sites ( P = 0.03), and late partial flap losses ( P = 0.03); and required more revisional surgery for flap ( P = 0.009) and donor sites ( P = 0.01). BREAST-Q scores were not statistically different for satisfaction with breasts or surgeon but were lower in MWL patients for psychosocial ( P = 0.01) and sexual well-being ( P = 0.04). CONCLUSIONS Reconstructive surgeons should expect increased postoperative complications when performing autologous breast reconstruction in patients who have experienced MWL. These patients should be counseled on the possibility of an increased risk of postoperative complications and need for revisional surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
| | | | | | | | | | | | - Niaman Nazir
- Population Health, University of Kansas Medical Center
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Histological Skin Assessment of Patients Submitted to Bariatric Surgery: A Prospective Longitudinal Cohort Study. Obes Surg 2023; 33:836-845. [PMID: 36627534 DOI: 10.1007/s11695-023-06453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Obesity is a stigmatizing disease that can cause dermatological aberrations, such as sagging after rapid weight loss. OBJECTIVE This study is to evaluate the effects of obesity and massive weight loss following bariatric surgery on collagen and elastic fibers of the extracellular matrix of the skin. METHODS Thirty-three skin biopsies were collected from patients prior to bariatric surgery and one year after surgery. Histological analyses were performed using hematoxylin-eosin and Weigert's resorcin-fuchsin staining for collagen and elastic and elaunin fibers, respectively. Differences between means were submitted to the Student's t-test or Mann-Whitney U test, with p < 0.05 significant. RESULTS The study demonstrated an architectural alteration of the skin 1 year after bariatric surgery. In the histological analysis of the skin samples, a significant difference in the thickness of the epidermis was found 1 year after surgery in all age groups as well as in the 38-to-68-kg weight loss group (p < 0.0001). In addition to laxity, disorganization of collagen was found, with an apparent decrease in quantity and an increase in elastic fibers, although fragmented (p < 0.0001). CONCLUSION Obesity and massive weight loss following bariatric surgery cause the disorganization of collagen fibers and the fragmentation of elastic fibers of the extracellular matrix of the skin.
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Evaluation of the outcome of a proposed more physiological bypass surgery technique in morbid obesity: Long term 3 years follows up. Ann Med Surg (Lond) 2022; 84:104952. [DOI: 10.1016/j.amsu.2022.104952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/25/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022] Open
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Silva ACF, Kazmarek LM, de Souza EM, Cintra ML, Teixeira F. Dermatological manifestations relating to nutritional deficiencies after bariatric surgery: case report and integrative literature review. SAO PAULO MED J 2022; 140:723-733. [PMID: 36043664 PMCID: PMC9514871 DOI: 10.1590/1516-3180.2021.0616.r1.17022022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The number of bariatric surgeries performed worldwide is growing. Among the main short, medium or long-term complications after surgery are nutritional deficiencies. Many of these, such as those of Zn, Cu and vitamins A, B1, B3, B6 and B12, are manifested by dermatological lesions before potentially fatal systemic disorders occur. OBJECTIVE To identify the main dermatological manifestations associated with nutritional deficiencies after bariatric surgery, and the associated variables. DESIGN AND SETTING Integrative literature review carried out at a public university in Brazil. METHODS This was a case report and a review of health research portals and databases of national and international biomedical journals, without publication date limitation. The descriptors used for searches followed the ideal methodology for each database/search portal: "bariatric surgery", "skin", "skin disease", "skin manifestation", "deficiency disease" and "malnutrition". RESULTS A total of 59 articles were selected, among which 23 were review articles or articles that addressed specific dermatological manifestations. The other 36 articles described 41 cases, which were organized into a table with the clinical variables. CONCLUSIONS Although nutritional deficiencies are expected as complications after bariatric surgery, few articles relating them to their dermatological manifestations were found. It is important to recognize skin changes caused by nutritional deficiencies in patients treated via bariatric surgery, as these may occur before systemic complications appear and are easier to diagnose when the patient does not have any systemic symptoms yet. However, there is generally a delay between the appearance of skin lesions and making the diagnosis of nutritional deficiency.
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Affiliation(s)
- Andressa Christine Ferreira Silva
- MD. Physician, Department of Pathology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Laura Moya Kazmarek
- MD. Physician, Department of Pathology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Elemir Macedo de Souza
- MD, PhD. Associate Professor with Tenure (Phased Retirement), Department of Dermatology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Maria Letícia Cintra
- MD, PhD. Professor and Head, Department of Pathology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Fernanda Teixeira
- MD, PhD. Consultant Professor, Department of Pathology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Lived Experience after Bariatric Surgery among Patients with Morbid Obesity in East Coast Peninsular Malaysia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106009. [PMID: 35627547 PMCID: PMC9140372 DOI: 10.3390/ijerph19106009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023]
Abstract
Living with morbid obesity is challenging since it affects various dimensions of life. Sustainable weight loss via bariatric surgery helps people suffering from morbid obesity to lead a healthy and meaningful life. This study highlights the challenges before bariatric surgery and the impact on one’s life. A phenomenological approach was employed using in-depth interviews with 21 participants (15 females and 6 males) who had undergone surgery at least 6 months prior to the study with the mean age of 42.6 years. Due to excess body weight, the physical limitation had a serious negative impact on their social life, making them targets of bias and stigmatisation. Surgery was the best option for them to attain sustainable weight loss and to lead a new life. However, a few participants struggled with the side effects of surgery. Five themes were discovered, namely, (1) social restraint; (2) experiencing bias and stigmatisation; (3) bringing new life; (4) boosting self-esteem; and (5) facing the negative side of surgery. This study serves as a platform to explore the difficulties faced by people with morbid obesity and the changes that the participants experienced after the surgery for future intervention to curb the rising number of people with morbid obesity.
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Darlenski R, Mihaylova V, Handjieva-Darlenska T. The Link Between Obesity and the Skin. Front Nutr 2022; 9:855573. [PMID: 35369048 PMCID: PMC8965625 DOI: 10.3389/fnut.2022.855573] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity as a multi-organ disease that affects the entire human organism. Notably, the skin is no exclusion from this postulate. Skin changes in obese patients have been widely studied with regards to mechanical friction, skin infections, and skin hypertrophic conditions, such as acanthosis nigricans and, most commonly, fibromas (skin tags). Almost 60–70% of obese patients present with a variety of skin changes. Herein, we discuss our own experience and review the complex skin changes in obesity. The role of metabolic syndrome and obesity are responsible for the epidemiological prevalence and are involved in the pathogenesis of chronic inflammatory skin diseases, such as psoriasis, atopic dermatitis, and skin malignancies. Here, we comment on the role of nutritional interventions in these patients as it has been proven that low-calorie diet and weight loss is related to improvement of inflammatory skin diseases. The readership of this paper will receive up-to-date overview on the connection between obesity and the skin that is of a practical importance to any clinician working in the field.
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Affiliation(s)
- Razvigor Darlenski
- Department of Dermatology and Venereology, Acibadem Cityclinic Tokuda Hospital, Sofia, Bulgaria
- Department of Dermatology and Venereology, Trakia University, Stara Zagora, Bulgaria
- *Correspondence: Razvigor Darlenski,
| | - Vesselina Mihaylova
- Department of Pharmacology and Toxicology, Medical Faculty, Medical University, Sofia, Bulgaria
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Sinik L, Egan KG, Patel K, Nazir N, Butterworth JA. A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients. Ann Plast Surg 2022; 88:353-359. [PMID: 34238794 DOI: 10.1097/sap.0000000000002940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Given global trends in obesity and bariatric surgeries, there are an increasing number of women presenting for breast reconstruction after massive weight loss. There is a paucity of literature about breast reconstruction after mastectomy in patients with a history of massive weight loss. A literature review revealed 10 articles that discussed outcomes of different reconstruction techniques in patients with massive weight loss. Autologous reconstruction techniques and implant-based reconstruction techniques were assessed to evaluate the advantages, disadvantages, and indications of each approach specific to this unique patient population. This article provides a summary of expected outcomes, including complication profiles. Ultimately, consideration should be given for breast reconstruction of mastectomy defects in patients with a history of massive weight loss, as satisfactory results are demonstrated to be possible. Both autologous reconstruction and implant-based reconstruction present feasible options, although reconstruction in this patient population may be associated with increased need for revisions and a higher complication rate compared with patients without a history of massive weight loss. For this reason, it is imperative to appropriately manage preoperative expectations in patients with a history of massive weight loss.
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Affiliation(s)
| | | | | | - Niaman Nazir
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
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Gasmi A, Bjørklund G, Mujawdiya PK, Semenova Y, Peana M, Dosa A, Piscopo S, Gasmi Benahmed A, Costea DO. Micronutrients deficiences in patients after bariatric surgery. Eur J Nutr 2021; 61:55-67. [PMID: 34302218 DOI: 10.1007/s00394-021-02619-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is an effective option for managing obesity and has gained general acceptance among patients in recent years. Generally, despite the high caloric intake, a bad nutritional habit of obese people results in the deficiency of several vitamins, minerals, and trace elements essential for body metabolism and normal physiological processes. Additionally, the current bariatric surgical approaches such as sleeve gastrectomy (SG), Roux-en-Y-gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and jejunoileal bypass (JIB) can cause or exacerbate these deficiencies. Based on several reports, it appears that the various bariatric surgical procedures affect nutrient absorption differently. Being purely restrictive, LAGB and SG affect the absorption of iron, selenium, and vitamin B12, while RYGB, JIB, and biliopancreatic diversion have a more profound impact on the absorption of essential vitamins, minerals, and trace elements. Nutritional deficiencies in vitamins, minerals, and trace elements may follow bariatric surgery and are associated with clinical manifestations and diseases, including anemia, ataxia, hair loss, and Wernicke encephalopathy. The present review summarizes some of the major vitamin and micronutrient deficiencies associated with bariatric surgery, particularly those presented post-surgically. To avoid any adverse consequences of vitamin and trace element deficiency, proper monitoring and tests are recommended at any stage, from pre- to post-surgery (periodical check-up), followed by specific and individual nutritional supplementation treatments and a proper healthy diet.
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Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
| | | | - Yuliya Semenova
- Semey Medical University, Semey, Kazakhstan
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Massimiliano Peana
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | - Alexandru Dosa
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Salva Piscopo
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
- Department of Nutritional Research and Development, Nutri-Logics SA, Weiswampach, Luxembourg
| | - Asma Gasmi Benahmed
- Académie Internationale de Médecine Dentaire Intégrative, Paris, France
- Université Claude Bernard, Lyon 1, Villeurbanne, France
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Chamberlain C, Terry R, Shtayyeh T, Martinez C. Recognizing postoperative nutritional complications of bariatric surgery in the primary care patient: a narrative review. J Osteopath Med 2021; 121:105-112. [PMID: 32975555 DOI: 10.7556/jaoa.2020.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bariatric surgery is an effective treatment for patients with morbid obesity. However, as safe and common as bariatric procedures have become, multiple complications can still result. These complications vary depending on the type of procedure performed (malabsorptive or restrictive) and are often nutritional derangements from the altered malabsorptive surface of the gastrointestinal tract and decreased capacity of the stomach. Deficiencies in vitamin D after malabsorptive procedures such as the Roux-en-Y gastric bypass can result in subsequent hypocalcemia and bone demineralization, and anemias can also present after surgery from inadequate vitamin B12 and iron absorption. Because of the prevalence of these deficiencies, baseline micronutrient testing and postoperative screening are recommended in many cases. Additionally, supplemental treatment often requires higher doses than those recommended for healthy adults. The purpose of this narrative review is to outline the various nutrient deficiencies that can result from bariatric procedures and report previously-published recommendations for screening and medical treatment of patients with these deficiencies. This review is directed toward primary care practitioners because of their unique position in delivering continuity of care and the frequency with which they will encounter patients who have undergone bariatric surgery and are seeking counseling regarding weight loss modalities.
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Itthipanichpong Y, Damkerngsuntorn W, Tangkijngamvong N, Udomsawaengsup S, Boonchayaanant P, Kumtornrut C, Kerr SJ, Asawanonda P, Rerknimitr P. Skin manifestations after bariatric surgery. BMC DERMATOLOGY 2020; 20:21. [PMID: 33298045 PMCID: PMC7726855 DOI: 10.1186/s12895-020-00120-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
Background Skin signs observed in morbid obesity may change as the weight reduces, especially post-bariatric surgery (BaS). Data concerning the skin findings exclusively in post-BaS patients remain limited. Methods Seventy post-BaS patients were examined for cutaneous abnormalities. The patients were divided into those with successful weight loss (% excessive body weight loss (EBWL) of at least 50%) and a non-successful group (%EBWL < 50%). Results Forty-six patients with successful weight loss demonstrated a significantly lower prevalence of acanthosis nigricans on the neck, axillae and inguinal areas, keratosis pilaris (KP) and pebble fingers. However, a higher prevalence of alopecia was observed. After adjustment with patients’ factors, KP (adjusted odds ratio (aOR) = 0.21, 95%CI 0.06–0.74, p = 0.02) and pebble fingers (aOR = 0.09, 95%CI 0.01–0.89, p = 0.04) remained significantly less likely in patients with successful weight loss. Laboratory results comparing pre- and post-surgery values revealed significant decreases in fasting plasma glucose, hemoglobin A1c, and triglyceride and an increase of high-density lipoproteins in both groups. However, significant decreases of liver aminotransferases (AST and ALT) were observed only in the successful group (p = 0.04, 0.003). Nonetheless, a decrease in vitamin B12 (p = 0.01) was observed in the successful group. Conclusion Weight loss after BaS provided an improvement for metabolic profiles. Successful weight reduction resulted in better skin improvement. However, nutritional supplements may be necessary. Trial registration Thai Clinical Trials Registry TCTR20171003002. Registered October 3. 2017, retrospectively registered.
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Affiliation(s)
- Yada Itthipanichpong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Wilawan Damkerngsuntorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Natsinee Tangkijngamvong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Suthep Udomsawaengsup
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patchaya Boonchayaanant
- Division of Endocrinology and Metabolism, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanat Kumtornrut
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Stephen J Kerr
- Center for Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pawinee Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Eghleilib M, Eghlileb A, Al-Alem I, Sriwi D, Elshaer AK. Peculiar Skin Rash After Laparoscopic Sleeve Gastrectomy. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920728. [PMID: 32669532 PMCID: PMC7377524 DOI: 10.12659/ajcr.920728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity is one of the leading causes of preventable death worldwide. Due to its increasing incidence and the difficulty in reducing its morbidity and mortality using nonsurgical methods, the demand for bariatric surgery has risen in recent times. Sleeve gastrectomy is one of the most common types of bariatric surgery, and like any other surgery, it carries a series of risks. CASE REPORT Although complications such as gastrointestinal leaks are widely reported, there is limited literature available on cutaneous complications. Here, we report 4 cases of patients showing a peculiar skin rash 2-4 weeks following sleeve gastrectomy. We also discuss some of the mechanisms that may underlie this correlation. CONCLUSIONS There is a need for further epidemiological studies to determine the prevalence of this rash. Further studies are also needed to determine the exact etiology of this rash.
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Affiliation(s)
- Mohamed Eghleilib
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Ahmed Eghlileb
- Department of Dermatology, Habib Medical Group, Sweidi Hospital, Riyadh, Saudi Arabia
| | - Ihasan Al-Alem
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dalia Sriwi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Impact of Lipo-Body Lift Compared to Classical Lower Body Lift on Postoperative Outcome and Patient's Satisfaction: A Retrospective Study. Aesthetic Plast Surg 2020; 44:464-472. [PMID: 31263934 DOI: 10.1007/s00266-019-01435-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Lately, the growing number of bariatric procedures performed each year led to an increasing demand for lower trunk reconstruction. Our team previously described the lipo-body lift (LBL) technique into lower duration of drainage and therefore seromas and other complications. In this study, we compared the classical body lift (CBL) technique to the LBL procedure. MATERIALS AND METHODS All patients who underwent a LBL or CBL after massive weight loss between November 2012 and October 2017 were included. Surgery outcome parameters were collected as well as patient satisfaction through a satisfaction score realized at least after 1 year postoperative. Comparisons between CBL and LBL were conducted to assess the surgery's safety and the patient's satisfaction. RESULTS A total of 130 patients were included, 61 patients who had a LBL were compared to 69 patients who had a CBL. The mean patient age was 39.64 ± 9.97 (21-66) years old, the mean body mass index before plastic surgery was 26.83 ± 3.08 kg/m2 (19.83-32.69), and the average weight loss was 53.40 ± 17.37 kg. The two groups had comparable preoperative data. Duration of drainage and hospital stay was significantly lower in the LBL group than in the CBL (p < 0.0001 and p < 0.0001, respectively). Surgical outcomes were comparable between groups as well as patient satisfaction scores. CONCLUSION Lipo-body lift allows early discharge of the patient by reducing the duration of drainage without increasing the risk for complications. In our opinion, this technique should be used for type 1 and 2 patients with no contraindication for abdominal liposuction. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Rosen J, Darwin E, Tuchayi SM, Garibyan L, Yosipovitch G. Skin changes and manifestations associated with the treatment of obesity. J Am Acad Dermatol 2019; 81:1059-1069. [DOI: 10.1016/j.jaad.2018.10.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
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Freitas J, Bliven P, Case R. Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass. BMJ Case Rep 2019; 12:12/8/e230605. [PMID: 31377720 DOI: 10.1136/bcr-2019-230605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) surgery and alcohol use presented with a confluent erythematous rash involving the perineum spreading outward to the abdomen, thighs and lower back. She had angular cheilitis and glossitis. The rash was painful and blistering in scattered areas. She was hypotensive and appeared to be in septic or hypovolemic shock at presentation. Serum levels of zinc and vitamin B6 were critically low and biopsy of her rash returned suggestive of a nutritional deficiency as its source. The rash slowly improved over the following 2 weeks with oral zinc and vitamin B6 replacement. The body rash resembled that of infants born with inherited defects in zinc transporters, referred to as acrodermatitis enteropathica (AE). This case may represent an acquired case of AE in the setting of prior RYGB.
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Affiliation(s)
- Jared Freitas
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
| | - Patrick Bliven
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Case
- Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
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Sherf-Dagan S, Goldenshluger A, Azran C, Sakran N, Sinai T, Ben-Porat T. Vitamin K-what is known regarding bariatric surgery patients: a systematic review. Surg Obes Relat Dis 2019; 15:1402-1413. [PMID: 31353233 DOI: 10.1016/j.soard.2019.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
Abstract
Vitamin K, a fat-soluble vitamin, is involved in blood coagulation, bone mineralization, inhibition of vascular calcification, and regulation of numerous enzyme systems. Patients who undergo bariatric surgery (BS), especially procedures that involve a malabsorptive component, are prone to develop vitamin K deficiency (VKD). The causes of VKD include decreased absorptive surface areas, steatorrhea, bacterial overgrowth, marked reduction of carriers of vitamin K, decrease in vitamin K intake, and modifications of gut microbiota. Data on vitamin K status among BS patients are scarce and the strength of evidence supporting vitamin K supplementation is weak. Thus, this systematic review summarized the scientific literature on vitamin K and examined the status among patients before and after BS, as well as among pregnant women with a history of BS. A MEDLINE/Pubmed and Embase electronic search was performed. After a thorough screening of 204 titles, 19 articles were selected by 2 independent reviewers. Five studies on BS candidates (n = 750), 12 studies after BS (n = 1442), and 4 studies on pregnant woman after BS (n = 83, of them n = 7 from case reports) were included. Results of the current review suggest that patients who undergo major malabsorptive surgeries are at a higher risk of developing VKD and should be better monitored. At this point, it is still unclear whether supplementation of vitamin K is required, and what oral dose or vitamer type should be used to normalize serum levels after different types of bariatric procedures. It should be noted that the current protocols for VKD treatment are still experiential in these patients. It is also unknown at what intervals screening tests for vitamin K should be performed and what assay is most appropriate for screening purposes. Future studies are needed to answer these unresolved issues.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel; The Israel Dietetic Association, Herzliya, Israel.
| | | | - Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel; Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Tali Sinai
- The Israel Dietetic Association, Herzliya, Israel; Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel; School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Tair Ben-Porat
- The Israel Dietetic Association, Herzliya, Israel; Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Affiliation(s)
- Audrey Patoué
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
- Department of Plastic, Reconstructive and Aesthetic Surgery, Trousseau Hospital, University of Tours, Tours, France
| | - Antoine De Runz
- Department of Maxillofacial, Plastic, Reconstructive and Cosmetic Surgery, Nancy University Hospital, Nancy, France
| | - Raphael Carloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Charles Nicolle Hospital, Rouen, France
| | - Sylvie Aillet
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
- INSERM U917, University of Rennes 1, Rennes, France
- SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France
- STROMAlab, UMR5273 CNRS/UPS/EFS-INSERM U1031, Rangueil Hospital, Toulouse, France
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The Lipo-Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery. Plast Reconstr Surg 2017; 139:38e-49e. [PMID: 28027231 DOI: 10.1097/prs.0000000000002926] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo-body lift method. The authors describe their experience with this novel, safe procedure. METHODS Twenty-five abdominal body-contouring reconstructions following massive weight loss were treated by means of circumferential lipo-body lift. The authors describe the indications for the procedure and their perioperative and postoperative management. RESULTS The mean patient age was 39.4 years. The mean pre-body lift body mass index was 26.71 kg/m; the average weight loss before surgery was 56.6 kg, with a mean delta body mass index loss of 20.82 kg/m. The average hospital stay was 3.52 days and the drainage duration 3.56 days. No patient experienced any major complication (e.g., hematoma, thromboembolism, bleeding, skin necrosis, or a need for revision surgery to treat complications). Minor complications including wound dehiscence, wound infection, and fat necrosis were reported in 40 percent of patients. The occurrence of complications was associated with smoking status (p = 0.0280), the volume of liposuction (p = 0.0399), and the liposuction volume per unit of body mass index (p = 0.0071). CONCLUSIONS The authors' novel technique is less invasive than the traditional lower body-lifting method, as shown by the absence of major complications, and allows excellent conservation of connective tissue and vessels; undermining is minimal. As obesity becomes a major problem worldwide, lifting procedures that are safe and effective are important components of reconstructive strategies and should be widely offered to patients who experience massive weight loss. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Bertheuil N, Carloni R, De Runz A, Herlin C, Girard P, Watier E, Chaput B. Medial thighplasty: Current concepts and practices. ANN CHIR PLAST ESTH 2016; 61:e1-7. [PMID: 26433317 DOI: 10.1016/j.anplas.2015.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/30/2015] [Indexed: 12/18/2022]
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