Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Abdominal Hypertension after Abdominal Plication in Postbariatric Patients: The Consequence in the Postoperative Recovery

  • Martin Morales-Olivera (Department of Plastic and Reconstructive Surgery in Hospital General de la Ciudad de Mexico ) ;
  • Erik Hanson-Viana (Department of Plastic and Reconstructive Surgery in Hospital General de la Ciudad de Mexico ) ;
  • Armando Rodriguez-Segura (Department of Plastic and Reconstructive Surgery in Hospital General de la Ciudad de Mexico "Dr. Ruben Lenero") ;
  • Marco A. Rendon-Medina (Department of Plastic and Reconstructive Surgery in Hospital General de la Ciudad de Mexico "Dr. Ruben Lenero")
  • Received : 2022.09.14
  • Accepted : 2023.06.29
  • Published : 2023.11.15
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Abstract

Background Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. Methods This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. Results We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m2; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. Conclusion Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.

Keywords

Acknowledgement

This paper and the research behind it would not have been possible without the support of the Post-bariatric Surgery Department in "Hospital General de Tlahuac" as well as all the doctors and nurses involve during the months of the protocol.

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