Zevallos Alba, Schmidt Jeremias, Thaher Omar, Bausch Dirk, Pouwels Sjaak
Universidad Cientifica del Sur, Lima, Universidad Cientifica del Sur, Lima, Peru.
Department of Plastic, Reconstructive and Aesthetic Surgery, Helios Klinik Berlin-Buch, Berlin, Department of Plastic, Reconstructive and Aesthetic Surgery, Helios Klinik Berlin-Buch, Berlin, Germany.
Obes Surg. 2025 Jul 1. doi: 10.1007/s11695-025-08021-1.
Lipedema often remains undiagnosed in patients with obesity, leading to mismanagement of treatment. Because of this, despite remarkable weight loss after bariatric surgery and decreases in hip and abdomen circumference, some patients show only small decreases in the circumference of the extremities and report persistent limb pain. We present the first scoping review to systematically explore the reported patient characteristics, clinical outcomes, and diagnostic challenges of lipedema in patients undergoing metabolic bariatric surgery, to identify gaps in current practice and promote earlier diagnosis and tailored treatment.
A search in PubMed, Embase, Medline, and Cochrane was conducted, from inception to December 19th, 2023. We consider as inclusion criteria original articles, case reports, and case series of lipedema after metabolic bariatric surgery.
Among the included studies, a total of 49 patients were reported, and all were female. The mean age of cases was 42.43 (range 24-63) years old, and the mean BMI was 49.92 kg/m. In the majority of the included patients, a sleeve gastrectomy was performed (25 patients, 51%), Roux-en-Y in 22 patients (45%), and One anastomosis Gastric Bypass in 2 (4%). Forty-eight patients had lipedema diagnosed after bariatric surgery. The mean excess weight loss was 70.93%, and the mean total weight loss was 36%. The mean pain score increased after surgery with 7.92 compared to 7.30 before surgery.
Recognizing the presence of lipedema in females experiencing extremity pain and disproportionate fat distribution is crucial. Bariatric surgery alone does not appear to significantly improve lipedema-related symptoms, based on currently available evidence, and even significant excess weight loss of more than 70% often fails to alleviate its associated pain.
脂肪性水肿在肥胖患者中常常未被诊断出来，导致治疗管理不当。因此，尽管减肥手术后体重显著减轻，髋部和腹部周长减小，但一些患者四肢周长仅略有减小，并报告持续的肢体疼痛。我们进行了首次范围综述，以系统地探讨代谢性减肥手术患者中已报道的脂肪性水肿患者特征、临床结局和诊断挑战，以识别当前实践中的差距，并促进早期诊断和个性化治疗。
在PubMed、Embase、Medline和Cochrane数据库中进行检索，检索时间从建库至2023年12月19日。我们将代谢性减肥手术后脂肪性水肿的原始文章、病例报告和病例系列作为纳入标准。
在所纳入的研究中，共报告了49例患者，均为女性。病例的平均年龄为42.43岁（范围24 - 63岁），平均体重指数为49.92kg/m²。在大多数纳入患者中，进行了袖状胃切除术（25例患者，51%），22例患者（45%）进行了Roux - en - Y胃旁路手术，2例患者（4%）进行了单吻合口胃旁路手术。48例患者在减肥手术后被诊断为脂肪性水肿。平均超重减轻率为70.93%，平均总体重减轻率为36%。术后平均疼痛评分从术前的7.30增加到7.92。
认识到存在肢体疼痛和脂肪分布不均的女性患者中脂肪性水肿的存在至关重要。根据现有证据，仅减肥手术似乎并不能显著改善与脂肪性水肿相关的症状，即使超过70%的显著超重减轻往往也无法缓解其相关疼痛。
