Difficulties of Bariatric Surgery after Abdominoplasty

Abstract

During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting fibrotic tissue and choosing new landmarks. We conclude that after abdominoplasty bariatric surgery can be performed safely either using conventional laparoscopic technique or robotically.

Failed pneumoperitoneum for laparoscopic surgery following autologous Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: a case report

“…Difficulties associated with performing laparoscopy in patients who have undergone prior abdominal wall surgery, such as abdominoplasty [ 1 , 2 , 4 , 25 ], umbilical hernia repair [ 26 ] and transverse rectus abdominis myocutaneous flap-based breast reconstruction [ 27 ], along with techniques to overcome such challenges, have been described previously. First, the altered abdominal wall anatomy resulting from previous surgery makes safe and proper trocar placement challenging.…”

“…First, the altered abdominal wall anatomy resulting from previous surgery makes safe and proper trocar placement challenging. The reconstructed umbilicus, which is often the anatomic landmark used to define the midline and inform placement of a Veress needle, may lie left or right of its native location [ 4 ]. In such cases, alternate stable landmarks can be used for reference, such as the xiphoid bone or the left subcostal pararectus region, Palmer’s point [ 28 ].…”

“…Second, trocar perforation can be difficult in patients with previous abdominal surgery if the abdominal wall is fibrotic or scarred [ 2 ]. Operative modifications for safe and effective port placement in this setting include providing counter traction with towel clamps and using sharp dissection to perforate fibrosis [ 4 ].…”

“…Loss of abdominal wall compliance was a major technical limitation described in a study detailing a technical approach to laparoscopic colectomy in patients who had previously undergone abdominoplasty [ 1 ]. The loss of abdominal wall compliance was thought secondary to fascial plication and skin removal [ 1 , 4 ]. To recruit additional abdominal space, some advocate placing patients into the reverse Trendelenburg position with flexion of the legs at the hips [ 31 ].…”

Cirugía postbariátrica: el último eslabón en el protocolo de cirugía metabólica

“…Algunos casos presentan adhesiones supraumbilicales, lo que puede limitar el movimiento del colgajo abdominal. 27 Los objetivos en el manejo del abdomen es lograr un vientre plano, plicar la musculatura abdominal, reparar hernias y reposicionar el monte de venus. Además, el manejo circunferencial del abdomen tiene la capacidad de modificar el contorno de los muslos laterales y los glúteos, por lo que suele conocerse como un lower body lift.…”