Background and Objective

Obesity is a global public health problem. Metabolic surgery causes a massive weight loss, and patients usually require reconstructive surgery with a high percentage of complications at the surgical site, mainly dehiscence.

Consequently, an analysis of histological changes on these patients and their relationship with wound evolution is required, stressing the differences between a patient who lost weight with diet and exercise (with prior overweight only), compared to one subjected to bariatric surgery.

Methods

We formed 4 groups of patients who would undergo abdominoplasty after weight loss until an optimal body mass index (BMI) was obtained. Group A (control group): patients who were overweight (BMI 25.1-29), losing weight only with diet and exercise, leading them to an acceptable BMI < 27.5. Group B: obesity Grade I (BMI 30-34.9). Group C: obesity Grade II (BMI 35-39.9). Group D: obesity Grade III / morbid obesity (BMI > 40). Groups B, C and D with weight loss after gastric bypass, leading to an acceptable BMI < 30. A biopsy was taken from the supraumbilical portion of the abdominal flap to be resected. Histological characteristics and their relationship with postoperative evolution were analyzed.

Results

80 patients were included (20 per group). 95% were female (76 patients), with an average age of 39.4 years old (range from 29 to 58). A p <0.0001 was obtained in relation to density and morphology of elastic and collagen fibers when comparing all obesity groups to the control group (overweight), as well as a relative risk 5 times higher of having ecchymosis and epidermolysis in obesity GIII; 8 times higher risk of having dehiscence in Obesity GII; and 14 times higher risk of dehiscence in grade III. There was no statistically significant difference for infections.

Conclusions

Patients with a higher degree of obesity (GII and III) have greater dermal histological alterations, with a directly proportional impact (increased relative risk) on the presence of ecchymosis, epidermolysis and dehiscence of wounds. Therefore, we should be aware of this problem when performing surgical closure, applying less pressure on edges.We recommend to take on count this phenomenon when performing a surgical procedure on a patient who lost weight after a gastric bypass, and so, a lower pressure must be applied to closure.

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