Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait city, Kuwait.
Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Room 4447, Halifax Infirmary, 4th Floor, Plastic Surgery, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
Aesthetic Plast Surg. 2021 Jun;45(3):1064-1075. doi: 10.1007/s00266-020-02016-2. Epub 2020 Oct 23.
Our main objective is to evaluate the effect of body contouring surgery (BCS) on the magnitude and durability of weight loss after bariatric surgery.
Medline, EMBASE, Cochrane, and Scopus search were conducted from the time of their inception to June 2020. We included comparative studies that assessed weight progression, in terms of Body Mass Index change (∆BMI), Total Body Weight Loss (TBWL%), and Excess Weight Loss (%EWL) for the post-bariatric patient population and the effect of BCS on weight progression.
Eleven articles were included. The pooled sample size was 2307, of which 691 were cases who underwent BCS post-bariatric surgery, and 1616 were comparative controls. The mean follow-up time for cases and controls were 61.6 ± 23.8 months and 52.2 ± 23.8 months, respectively. Nine studies reported results of BMI changes, six provided %EWL, and five used %TBWL. Significant improvement in weight loss was observed in the BCS group when measured by either ∆BMI (3 kg/m2 points decrease, p 0.023), %TBWL (6% increase, P < 0.0001), or %EWL (14% increase, P < 0.0001). Sub-group analysis showed that increased follow-up time was associated with higher TBWL% (p 0.02).
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. 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.
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.
我们的主要目的是评估身体塑形手术（BCS）对减重手术后体重减轻幅度和持久性的影响。
从创建之初到 2020 年 6 月，我们对 Medline、EMBASE、Cochrane 和 Scopus 进行了搜索。我们纳入了评估减重后患者群体体重进展情况的比较研究，包括身体质量指数变化（∆BMI）、总体重减轻（TBWL%）和超重减轻（%EWL），以及 BCS 对体重进展的影响。
纳入了 11 篇文章。汇总样本量为 2307 例，其中 691 例为减重后接受 BCS 的病例，1616 例为对照。病例和对照组的平均随访时间分别为 61.6±23.8 个月和 52.2±23.8 个月。9 项研究报告了 BMI 变化的结果，6 项提供了 %EWL，5 项使用了 %TBWL。BCS 组的体重减轻情况明显改善，∆BMI（下降 3kg/m2，p<0.023）、%TBWL（增加 6%，P<0.0001）或 %EWL（增加 14%，P<0.0001）。亚组分析显示，随访时间延长与 TBWL%升高相关（p<0.02）。
本综述提供的证据强烈支持，对于接受减重手术后大量减重的患者，选择合适的患者进行身体塑形手术具有长期获益。建议肥胖患者在接受减重手术的过程中，建立一个多学科团队，包括减重外科医生和整形外科医生，以及营养师和心理学家，对患者进行管理。
证据等级 III：本杂志要求作者为每篇文章指定一个证据等级。有关这些基于证据的医学分级的完整描述，请参考目录或在线作者指南 www.springer.com/00266。
