Concomitant Early Abdominoplasty and Sleeve Gastrectomy can destroy the Triangle of Danger of Obesity, Bad Quality of Life and Depression in Obese Patients.
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Objectives: To evaluate the impact of concomitant open sleeve gastrectomy (SG) and early abdominoplasty on weight, quality of life (QOL) and psychological status of obese patients assigned for bariatric surgery. Patients & Methods: The study included 50 patients with body mass index (B1vfl) >30 kg/m2. All patients underwent determination of body weight (SW), height and calculation of BM1 and the presence and frequency of concomitant medical co-morbidities. Operative procedure included initial abdominoplasty followed by open SG. Operative time, hospital stay, intraoperative and postoperative (PO) complications were registered. PO monitoring included evaluation of excess weight loss (EWL) determined at time of hospital discharge and at 3 and 6 months after surgery. All patients completed the impact of weight on QOL (IWQ0L) questionnaire and Beck depression inventory (BDI) preoperatively and at 3- and 6-months PO. BDI was additionally repeated at time of discharge. Results: All patients passed uneventful intraoperative course without complications. Mean total operative time was 158.9±22.7; range: 115-220 min and total intraoperative blood loss was 267.3±52.2; range: 175-375 ml. Mean weight of lipectomy specimen was 2.9±0.9; range: 2-6 kg. Mean duration of ICU stay was 1.5±0.5 days. PO complications included 10 obesity-related complications; 7 patients developed reflux esophagitis and 10 abdominoplasty-related complications. Mean SW determined at hospital discharge and at 3 and 6-m PO were significantly lower compared to preoperative SW. Patients' distribution among low BMI strata showed progressive significant increase with progress of time compared to preoperative distribution. All patients showed bad preoperative impact of weight on their QOL, but showed progressive improvement with significantly lower total IWQ0L scoring at 3-m and 6-m PO compared to preoperative scoring. All patients had bad preoperative mood up to extreme depression because of their weight and its impact on their QOL. At time of hospital discharge, loss of the abdominal belly improved patients' mood manifested as significant decrease of BDI scoring. Improved mood continued during PO period with significantly lower BD! score and frequency among higher depression grades at 3-m and 6-m compared to preoperative scoring. There was positive significant correlation between SW and IWQ0L and BDI scores with a positive significant correlation between scores of both questionnaires.