Plastic surgery improves long-term weight control after bariatric surgery.
BACKGROUND
The positive impact of Roux-en-Y gastric bypass on weight, comorbidities, and health-related quality of life is well documented. However, 50 percent of patients regain some of the lost weight after 2 years with Roux-en-Y gastric bypass and present a mean weight regain of 10 to 15 percent after several years, partially losing the previously obtained benefits. The authors hypothesize that body contouring could decrease weight regain, leading to better long-term weight control after Roux-en-Y gastric bypass.


METHODS
In a matched control study, variations in weight for 98 patients with body contouring after Roux-en-Y gastric bypass were compared with those of 102 matched control patients with Roux-en-Y gastric bypass alone. Data were collected prospectively at 1, 3, 6, 9, 12, and 18 months after Roux-en-Y gastric bypass and then yearly until 7 years.


RESULTS
After a massive mean weight loss of 45.2 kg during the first 2 years after Roux-en-Y gastric bypass, patients with Roux-en-Y gastric bypass alone presented a higher continuous mean weight regain than those with Roux-en-Y gastric bypass and body contouring (1.78 kg/year versus 0.51 kg/year of weight regain, respectively; p = 0.001). After 7 years, patients with Roux-en-Y gastric bypass presented significantly higher mean weight regain than patients with Roux-en-Y gastric bypass and body contouring (i.e., 10.8 percent versus 3.6 percent mean weight gain, respectively; p < 0.001). Netting out mean skin excision weight of 2.04 kg by body contouring, the weight regain was 22.9 kg for patients with Roux-en-Y gastric bypass alone and only 6.2 kg for those with Roux-en-Y gastric bypass and body contouring.


CONCLUSIONS
The authors demonstrated that patients with body contouring present better long-term weight control after Roux-en-Y gastric bypass. Therefore, body contouring must be considered as a reconstructive operation in the treatment of morbid obesity.


METHODS
Therapeutic, III.
Geneva, Switzerland From the Plastic, Reconstructive and Aesthetic Surgery Department, the General Surgery Department, and the Division of Clinical Epidemiology, Center of Clinical Research, University Hospitals of Geneva, University of Geneva.
Nicolas
N
Balagué
Christophe
C
Combescure
Olivier
O
Huber
Brigitte
B
Pittet-Cuénod
Ali
A
Modarressi
D000328:Adult; D001828:Body Image; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000523:psychology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life; D013518:Surgery, Plastic; D015430:Weight Gain; D015431:Weight Loss