Body Contouring Surgery in Post-Bariatric Patients

The dramatic rise of morbid obesity worldwide and the success of bariatric surgery results in a significant rise in the demand for post-bariatric body contouring surgery, a new field in plastic surgery. This makes a national clinical guideline for patient selection and treatment mandatory. In developing such a guideline, we should get more insight in risk factors for complications, post-bariatric patient’s concerns and expectations of the postoperative result and the expected result of body contouring surgery on short and long-term quality of life. The underlying purpose of this thesis is improvement of care for post-bariatric patients presenting for body-contouring surgery. The first part of this thesis focuses on patient selection. In chapter 2 we analyzed the nutritional deficiencies after gastric bypass surgery. This chapter answers the question at what time most deficiencies occur after the operation and what the value is of preoperative laboratory control. Chapter 3 presents a validation study of the Pittsburgh Rating Scale (PRS). The applicability of this classification system for clinical use in The Netherlands is discussed. The motives, barriers and expectations of massive weight loss patients concerning body contouring surgery are outlined in chapter 4 and this chapter contains a preoperative checklist, which can be used in the screening of candidates for body contouring surgery. The second part addresses the question if the quality of life improves on the short (chapter 5) and long-term (chapter 6) after body contouring surgery. In the third part we focus on post-operative complications. In chapter 7 we analyzed the results of body contouring surgery in patients after laparoscopic gastric banding and in chapter 8 we studied the complications in post-gastric bypass patients. The last part of this thesis contains a general discussion in which we will provide the overall implications of this thesis and recommendations for the care of the post-bariatric patient (chapter 9). This thesis is completed with a summary of the results (chapter 10).