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CC BY 4.0 · Arch Plast Surg 2023; 50(06): 535-540
DOI: 10.1055/s-0043-1772587
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Original Article

Abdominal Hypertension after Abdominal Plication in Postbariatric Patients: The Consequence in the Postoperative Recovery

Martin Morales-Olivera 
1   Department of Plastic and Reconstructive Surgery in Hospital General de Tláhuac, Mexico City, Mexico
,
Erik Hanson-Viana 
2   Department of Plastic and Reconstructive Surgery in Hospital General de la Ciudad de México “Dr. Rúben Leñero,” Mexico City, Mexico
,
Armando Rodríguez-Segura 
1   Department of Plastic and Reconstructive Surgery in Hospital General de Tláhuac, Mexico City, Mexico
,
Marco A. Rendón-Medina 
2   Department of Plastic and Reconstructive Surgery in Hospital General de la Ciudad de México “Dr. Rúben Leñero,” Mexico City, Mexico
› Author Affiliations Funding None.
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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

postbariatric surgery - intra-abdominal pressure - postoperative recovery - abdominal plicature - abdominal hypertension

Authors' Contribution

M.M.O. was the main author who made the protocol and had the idea of this study. E.H.V. was the one who did all the statistical analysis and helped in the development of this paper. A.R.S. is one of the senior authors, was present in all the surgeries, and helped with the development of this study. M.A.R.M. helped wright this paper, as well as gather patient information, and gather patient consents statements.


Ethical Approval

The study was approved by the Institutional Review Board of Hospital General de Tláhuac, Mexico City (IRB No. HGTIRB 2019-06-006) and performed in accordance with the principles of the Declaration of Helsinki. The requirement of informed consent was waived owing to the retrospective nature of the study.


Patient Consent

Written informed consent was obtained from the patient.




Publication History

Received: 14 September 2022

Accepted: 29 June 2023

Article published online:
30 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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