الفهرس 
ObesityOnly 14 pages are availabe for public view
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Abstract
Bariatric surgery remains the most effective solution to weight loss for the morbidly obese.
Laparoscopic gastric bypass have been commonly performed for that purpose and right now laparoscopic sleeve gastrectomy is also performed frequently.
Massive weight loss is defined as a DROP of 50% or more of excess body weight. As a growing number of patients undergo bariatric surgery, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities.
The development of sagging skin is a recognized sequence of weight-loss operations. The sudden change in body mass index (BMI) after rapid weight loss lowers skin tone and leads to a failure of the excess soft tissue to retract, resulting in redundant skin.
The redundant skin is commonly located on the abdomen, breast, upper arms, inside of the thighs, and back. Biörserud, et al., concluded in their study that women are more liable than men to have redundant skin over the upper arms, thighs, and flanks.
No correlation has been recorded between redundant skin and the patient’s satisfaction with his/her appearance. Surprisingly, morbidly obese patients become less satisfied with their body image (BI) with increasing weight loss. Quality of life (QOL) and BI are the most important aspects of patient satisfaction after aesthetic surgery.
Surgical reduction in weight has been shown to be of some benefit in terms of BI and function. The change in appearance after massive weight loss is expected to positively alter the patient’s BI and QOL.
Few people who have experienced a significant change in BI undergo body contouring surgeries. However, this might be because patients continue to have body image dissatisfaction (BID) due to residual feelings of being unattractive and self-conscious. Moreover, opinion is divided on whether body contouring surgery after weight loss is an insignificant additional procedure or a necessary second step after bariatric surgery.
This systematic review was conducted on all patients who underwent body contouring surgeries following massive weight loss in post bariatric surgery and aimed to determine whether those surgeries improves quality of life and body image or not. Systematic search of the following online databases PubMed (PM), Web Of Science, Scopus and Egyptians Universities Libraries Consortium (EULC). Reference lists of all eligible records were searched manually to identify any other relevant records, studies validity was done using PRISMA template and standard meta-analysis was performed.
The database search yielded 833 records in total (PM=215, WOS=299, Scopus=278, EULC=41; last accessed 25th February 2022). After removal of duplicated records, 536 records remained to be screened for eligibility.
After title/abstract screening 492 records were excluded, while 44 were considered for full-text assessment. Subsequently, 26 full-text records were excluded, while 18 records were included in the systematic review (van der Beek 2012, Bloom et al 2012, Singh 2012, Modaressi 2012, Azin 2013, De Zwaan et al 2014, Berthuil 2014, De Runz 2015, Tremp 2015, Song 2016, Suijker et al. 2017, Vierhapper et al 2017, Repo et al 2019, Rosa et al 2019, Cai 2019, Meal 2019, Monpellier et al 2019, Paul et al 2020).
Out of the 18 studies, three studies were cross-sectional, six prospective, nine retrospective cohort studies.
The oldest of the included studies was Van der beek 2012, while the most recent was Paul et al 2020.
Three studies were conducted in each of France, united states of America, two studies were conducted in each of Germany, Switzerland, Netherlands, while one study was conducted in each of Poland, Canada, chile, brazil, finland, Austria.
The highest sample size was 130 patients in meal 2019 and lowest was 10 patients in Azin 2013.
The most commonly done bariatric surgery was Roux-en-Y Gastric bypass, and other surgeries were laperscopic sleeve gastrectomy and Adjustable Gastric banding, with Highest mean Max BMI was 52.0+/-8.81kg/m2 in Bloom et al 2012 and lowest mean MAX BMI was 40 kg/m2 in Paul et al 2020. the Excess weight loss% following bariatric surgery, the highest was 86.3+/-13.6 % in Virehapper et al 2017 and the lowest was 36.8+/-8 % in Monpellier et al 2019.
The most commonly done Body contouring surgery was Abdominoplasty and other surgeries were brachioplasty, lower body lift, thigh lift, mammoplasty (mastopexy, breast reduction), upper body lift, panniculectomy, lipo-abdominoplasty, classical body lift, medial thigh lift, buttock lift. the highest mean BMI before body contouring was 31.6+/-7.4kg/m2 in Singh et al 2012 and the lowest was 25kg/m2 in Paul et al 2020, with the highest mean follow up time was 8 years (96 months) in tremp 2015 study and the lowest was 3 months in Bloom et al 2012.
The Quality of life and Body image assessment was done using the Moorhead-Arldelt QOL questionnaire in each of the following five studies, cai 2019, Rosa et al 2019, Tremp 2015, Berthuil 2014,Modaressi 2012, with the highest mean score was 2.1+/-0.9 in Rosa et al 2019 and the lowest was 0.7 in Tremp 2015.
The Short-form 36 questionnaire (SF-36) was used in three studies, Singh et al 2012 by 78.37, Azin 2013 by 56.8+/- 4.88 and Song 2016.
The Body Q questionnaire was used in three studies, Paul et al 2020 by 7.38+/-19.02 and Repo et al 2015 by 95 and Suijker et al. 2017 by 84.4+/- 12.7
Others questionnaires were as following ; Monpellier et al 2019 used un pubished questionnaire developed by the author and Meal 2015 used a Five point scale Questionnaire, Body Appraisal Questionnaire, body image questionnaire, body lift follow up questionnaire were used by Virehapper et al 2017, while De Runz 2017 used a self-designed Questionnaire, Zwann et al 2015 used (Multidimensial Body-self Relations Questionnaire, MBSRQ), Bloom et al used 15 mons satisfaction questionnaire and Van der Beek 2012 used the obesity psychosocial state questionnaire
In summary, with more evidence accumulating in the literature, plastic surgeons appear to play an important role in improving quality of life in patients suffering from obesity, and their integration into the bariatric pathway is recommended.
Conclusion
The evidence provided in this review strongly supports the added long-term benefits of body contouring surgery for selected patients after massive weight loss following bariatric surgery and current review demonstrated that BCS in postbariatric patients results in statistically significant improvements in numerous indicators of QOL.
Recommendations
Having a multidisciplinary team that involves a bariatric and a plastic surgeon as well as nutritionists and psychologists for the management of patients with obesity going through the bariatric pathway is recommended.
Because these patients tend to have multiple co-morbidities, nutritional deficiencies, and some present as complicated cases, optimization of patient safety is vital and can be best achieved by following international guidelines.
Future studies should attempt to adjust for certain confounding variables, such as the type of bariatric and body contouring surgery performed, the weight of skin excised during body contouring surgery, and the number of body contouring procedures performed and their effects on weight loss parameters.