Skip to main content

Advertisement

SpringerLink
Log in

Increased Intraoperative Bleeding in Patients Undergoing Abdominoplasty After Gastroplasty is not Due to Coagulopathy

  • Original Article
  • Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Abdominoplasties carried out in patients previously underwent gastroplasty present high rates of complications, including increased bleeding in the intra- and postoperative periods.

Methods

This study evaluated bleeding, coagulation parameters (coagulogram, dosage of fibrinogen, FII, FV, FVII, FVIII, FIX, FX, and FXII), and thromboelastography in two groups of women who underwent abdominoplasties: a group with a history of gastroplasty by the Fobi–Capella technique (group I) and the other group without a history of obesity (group II). Analyses were performed before, during, and after each surgical procedure. Vitamins K and C were also dosed. Bleeding was measured by counting and weighing compresses at the end of each surgery, and the withdrawn surgical specimens were weighed.

Results

Statistically, group I patients had more bleeding than group II in all evaluated operative periods (p = 0.007). There was no significant change in the coagulogram or decrease in coagulation factors that could be associated with increased bleeding in any of the analyzed groups. Thromboelastography, which provides a comprehensive analysis of thrombin generation and of hemostasis in real time, did not differ between groups. Vitamin K was significantly increased in group I patients (p = 0.019). The weight of the surgical specimens removed was significantly higher in group I (p = 0.007) and there was correlation of the weight with the degree of bleeding.

Conclusions

The results of this study demonstrate an increase of bleeding during the intraoperative period of abdominoplasty in patients with a history of gastroplasty that it is not due to changes in hemostasis.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Costa LF, Landecker A, Manta AM (2004) Optimizing body contour in massive weight loss patients: the modified vertical abdominoplasty. Plast Reconstr Surg 114(7):1917–1923

    Article  PubMed  Google Scholar 

  2. Ellaban MG, Hart NB (2004) Body contouring by combined abdominoplasty and medial vertical thigh reduction: experience of 14 cases. Br J Plast Surg 57(3):222–227

    Article  Google Scholar 

  3. Kinz JF, Traweger C, Trefalt E, Biebl W (2003) Psychosocial consequences of weight loss following gastric banding for morbid obesity. Obes Surg 13(1):105–110

    Article  Google Scholar 

  4. Vastine VL, Morgan RF, Williams GS, Gampper TJ, Drake DB, Knox LK et al (1999) Wound complications of abdominoplasty in obese patients. Ann Plast Surg 42(1):34–39

    Article  PubMed  CAS  Google Scholar 

  5. Shermak MA, Chang DC, Heller J (2007) Factors impacting thromboembolism after bariatric body contouring surgery. Plast Reconstr Surg 119(5):1590–1596

    Article  PubMed  CAS  Google Scholar 

  6. MacGohan LD (2007) Body contouring following major weight loss. J Contin Educ Nurs 38(3):103–104

    Google Scholar 

  7. Wolf AM, Kuhlmann HW (2007) Reconstructive procedures after massive weight loss. Obes Surg 17(3):355–360

    Article  PubMed  Google Scholar 

  8. Gmür RU, Banic A, Erni D (2003) Is it safe to combine abdominoplasty with other dermolipectomy procedures to correct skin excess after weight loss? Ann Plast Surg 51(4):353–357

    Article  PubMed  Google Scholar 

  9. Arthurs ZM, Cuadrado D, Sohn V, Wolcott K, Lesperance K, Carter P et al (2007) Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg 193(5):567–570

    Article  PubMed  Google Scholar 

  10. Manahan M, Shermak M (2006) Massive panniculectomy after massive weight loss. Plast Reconstr Surg 117(7):2191–2197

    Article  PubMed  CAS  Google Scholar 

  11. Shermak MA (2006) Hernia repair and abdominoplasty in gastric bypass patients. Plast Reconstr Surg 117(4):1145–1150

    Article  PubMed  CAS  Google Scholar 

  12. Fobi MA (1997) Gastric bypass: standard surgical technique. Obes Surg 7(6):518–520

    Article  PubMed  CAS  Google Scholar 

  13. Capella JF, Capella RF (1996) The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass? Am J Surg 171(1):74–79

    Article  PubMed  CAS  Google Scholar 

  14. Capella RF, Capella JF, Mandec H, Nath P (1991) Vertical banded gastroplasty-gastric bypass: preliminary report. Obes Surg 1(4):389–395

    Article  PubMed  Google Scholar 

  15. Pitanguy I (1981) Abdomen. In: Pitanguy I (ed) Aesthetic plastic surgery of head and body. Springer, Berlin, pp 99–128

    Chapter  Google Scholar 

  16. Mood AM, Graybill FA (1963) Introduction to the theory of statistics, 2nd edn. McGraw-Hill, New York, p 443

    Google Scholar 

  17. Morettin PA, Bussab WO (2002) Estatística básica, 5th edn. Saraiva, São Paulo, p 526

    Google Scholar 

  18. Ziccard P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M et al (2002) Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 105(7):804–809

    Article  Google Scholar 

  19. Bastard JP, Maachi M, Van Nhieu JT, Jardel C, Bruckert E, Grimaldi A et al (2002) Adipose tissue IL-6 content correlates with resistance to insulin activation of glucose uptake both in vivo and in vitro. J Clin Endocrinol Metab 87(5):2084–2089

    Article  PubMed  CAS  Google Scholar 

  20. Kern PA, Ranganathan S, Li C, Wood L, Ranganathan G (2001) Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab 280(5):E745–E751

    PubMed  CAS  Google Scholar 

  21. Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW (1999) C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 19(4):972–978

    Article  PubMed  CAS  Google Scholar 

  22. Machado FR, Cesar MS (2010) Sepsis, coagulation and anticoagulants. Endocr Metab Immune Disord Drug Targets 10(3):204–213

    Article  PubMed  CAS  Google Scholar 

  23. Stief TW, Ijagha O, Weiste B, Herzum I, Renz H, Max M (2007) Analysis of hemostasis alterations in sepsis. Blood Coagul Fibrinolysis 18(2):179–186

    Article  PubMed  CAS  Google Scholar 

  24. Pottmeyer E, Vassar MS, Holcroft JW (1986) Coagulation, inflammation, and responses to injury. Crit Care Clin 2(4):683–703

    PubMed  CAS  Google Scholar 

  25. Aly AS, Cram AE, Heddens C (2004) Truncal body contouring surgery in the massive weight loss patient. Clin Plast Surg 31(4):611–624

    Article  PubMed  Google Scholar 

  26. Tieu BH, Holcomb JB, Schreiber MA (2007) Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg 31(5):1055–1064

    Article  PubMed  Google Scholar 

  27. Hess JR, Hiippala S (2005) Optimizing the use of blood products in trauma care. Crit Care 9(Suppl 5):S10–S14

    Article  PubMed  Google Scholar 

  28. Kermode JC, Zheng Q, Milner EP (1999) Marked temperature dependence of the platelet calcium signal induced by human von Willebrand factor. Blood 94(1):199–207

    PubMed  CAS  Google Scholar 

  29. Gravante G, Araco A, Araco F, Delogu D, Filingeri V, Cervelli V (2006) Postobese patients and inherent surgical complications. Ann Plast Surg 56(5):585–586

    Article  PubMed  CAS  Google Scholar 

  30. Baptista LS, da Silva KR, da Pedrosa CS, Claudio-da-Silva C, Carneiro JR, Aniceto M et al (2009) Adipose tissue of control and ex-obese patients exhibit differences in blood vessel content and resident mesenchymal stem cell population. Obes Surg 19(9):1304–1312

    Article  PubMed  Google Scholar 

  31. McKenna R (2001) Abnormal coagulation in the postoperative period contributing to excessive bleeding. Med Clin North Am 85(5):1277–1310

    Article  PubMed  CAS  Google Scholar 

  32. Souto LR, Schenka AA, Vassallo J, Bizzacchi JM, Chaim EA (2010) Subcutaneous angiogenesis in patients undergoing plastic surgery procedures after weight-reducing gastroplasty: a reason for increased bleeding during intra- and postoperative periods? Eur J Plast Surg 33(6):341–348

    Article  Google Scholar 

  33. Fujioka K (2005) Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care 28(2):481–484

    Article  PubMed  Google Scholar 

  34. Mason ME, Jalagani H, Vinik AI (2005) Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am 34(1):25–33

    Article  PubMed  Google Scholar 

  35. Rubin JP, Nguyen V, Schwentker A (2004) Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg 31(4):601–610

    Article  PubMed  Google Scholar 

  36. Ukleja A, Stone RL (2004) Medical and gastroenterologic management of the post-bariatric surgery patient. J Clin Gastroenterol 38(4):312–321

    Article  PubMed  Google Scholar 

  37. Faintuch J, Matsuda M, Cruz ME, Silva MM, Teivelis MP, Garrido AB Jr et al (2004) Severe protein-calorie malnutrition after bariatric procedures. Obes Surg 14(2):175–181

    Article  PubMed  Google Scholar 

  38. Moize V, Geliebter A, Gluck ME, Yahav E, Lorence M, Colarusso T et al (2003) Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg 13(1):23–28

    Article  PubMed  Google Scholar 

  39. Blee TH, Cogbill TH, Lambert PJ (2002) Hemorrhage associated with vitamin C deficiency in surgical patients. Surgery 131(4):408–412

    Article  PubMed  Google Scholar 

  40. Ghorbani AJ, Eichler C (1994) Scurvy. J Am Acad Dermatol 30(5 Pt 2):881–883

    Article  PubMed  CAS  Google Scholar 

  41. Muskett A, Barber WH 5th, Lineaweaver WC (2005) The plastic surgeon’s guide to drugs affecting hemostasis. Ann Plast Surg 54(5):570–576

    Article  PubMed  CAS  Google Scholar 

  42. Cavallini M, Baruffaldi Preis FW, Casati A (2005) Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery. Plast Reconstr Surg 116(1):316–321

    Article  PubMed  CAS  Google Scholar 

  43. Gando S, Tedo I, Kubota M (1992) Posttrauma coagulation and fibrinolysis. Crit Care Med 20(5):594–600

    Article  PubMed  CAS  Google Scholar 

  44. Enderson BL, Chen JP, Robinson R, Maull KI (1991) Fibrinolysis in multisystem trauma patients. J Trauma 31(9):1240–1246

    Article  PubMed  CAS  Google Scholar 

  45. Aucar JA, Norman P, Whitten E, Granchi TS, Liscum KR, Wall MJ, Mattox KL (2003) Intraoperative detection of traumatic coagulopathy using the activated coagulation time. Shock 19(5):404–407

    Article  PubMed  Google Scholar 

  46. Goh KY, Tsoi WC, Feng CS, Wickham N, Poon WS (1997) Haemostatic changes during surgery for primary brain tumors. J Neurol Neurosurg Psychiatry 63(3):334–338

    Article  PubMed  CAS  Google Scholar 

  47. Schreiber MA, Differding J, Thorborg P, Mayberry JC, Mullins RJ (2005) Hypercoagulability is most prevalent early after injury and in female patients. J Trauma 58(3):475–480

    Article  PubMed  Google Scholar 

  48. Oshita K, Az-ma T, Osawa Y, Yuge O (1999) Quantitative measurement of thromboelastography as a function of platelet count. Anesth Analg 89(2):296–299

    PubMed  CAS  Google Scholar 

  49. Chandler WL (1995) The thromboelastography and the thromboelastograph technique. Semin Thromb Hemost 21(Suppl 4):1–6

    PubMed  Google Scholar 

  50. Sorensen B, Johansen P, Christiansen K, Woelke M, Ingerslev J (2003) Whole blood coagulation thrombelastographic profiles employing minimal tissue factor activation. J Thromb Haemost 1(3):551–558

    Article  PubMed  CAS  Google Scholar 

  51. Marchal G, Leroux ME, Samama MM (2003) Atlas of thrombodynamography. Haemoscope Corporation, Niles

    Google Scholar 

  52. Goldenberg NA, Hathaway WE, Jacobson L, Manco-Johnson MJ (2005) A new global assay of coagulation and fibrinolysis. Thromb Res 116(4):345–356

    Article  PubMed  CAS  Google Scholar 

  53. Brummel-Ziedins KE, Pouliot RL, Mann KG (2004) Thrombin generation: phenotypic quantification. J Thromb Haemost 2(2):281–288

    Article  PubMed  CAS  Google Scholar 

  54. Rivard GE, Brummel-Ziedins KE, Mann KG, Fan L, Hofer A, Cohen E (2005) Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thromboelastography. J Thromb Haemost 3(9):2039–2043

    Article  PubMed  CAS  Google Scholar 

  55. Abrahams JM, Torchia MB, McGarvey M, Putt M, Baranov D, Sinson GP (2002) Perioperative assessment of coagulability in neurosurgical patients using thromboelastography. Surg Neurol 58(1):5–11

    Article  PubMed  Google Scholar 

  56. Wilson D, Cooke EA, McNally MA, Wilson HK, Yeates A, Mollan RA (2001) Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture. Injury 32(10):765–770

    Article  PubMed  CAS  Google Scholar 

  57. Mahla E, Lang T, Vicenzi MN, Werkgartner G, Maier R, Probst C et al (2001) Thromboelastography for monitoring prolonged hypercoagulability after major abdominal surgery. Anesth Analg 92(3):572–577

    Article  PubMed  CAS  Google Scholar 

  58. Salooja N, Perry DJ (2001) Thrombelastography. Blood Coagul Fibrinolysis 12(5):327–337

    Article  PubMed  CAS  Google Scholar 

  59. Kaufmann CR, Dwyer KM, Crews JD, Dols SJ, Trask AL (1997) Usefulness of thromboelastography in assessment of trauma patient coagulation. J Trauma 42(4):716–720; discussion 720–722

    Google Scholar 

  60. Kang Y (1995) Thromboelastography in liver transplantation. Semin Thromb Hemost 21(Suppl 4):34–44

    PubMed  Google Scholar 

  61. Kang YG, Martin DJ, Marquez J, Lewis JH, Bontempo FA, Shaw BW Jr et al (1985) Intraoperative changes in blood coagulation and thromboelastographic monitoring in liver transplantation. Anesth Analg 64(9):888–896

    Article  PubMed  CAS  Google Scholar 

  62. von Kier S, Smith A (2000) Hemostatic product transfusions and adverse outcomes: focus on point-of-care testing to reduce transfusion need. J Cardiothorac Vasc Anesth 14(3 Suppl 1):15–21

    Google Scholar 

  63. Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA (1999) Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 88(2):312–319

    PubMed  CAS  Google Scholar 

  64. Di Benedetto P, Baciarello M, Cabetti L, Martucci M, Chiaschi A, Bertini L (2003) Thrombelastography: present and future perspectives in clinical practice. Minerva Anestesiol 69(6):501–515

    PubMed  Google Scholar 

  65. Kaneko T, Fujii S, Matsumoto A, Goto D, Makita N, Hamada J et al (2003) Induction of tissue factor expression in endothelial cells by basic fibroblast growth factor and its modulation by fenofibric acid. Thromb J 1(1):6–14

    Article  PubMed  Google Scholar 

  66. Bokarewa MI, Morrissey JH, Tarkowski A (2002) Tissue factor as a proinflammatory agent. Arthritis Res 4(3):190–195

    Article  PubMed  CAS  Google Scholar 

  67. Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B (1997) Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidosis revisited. J Trauma 42(5):857–861

    Article  PubMed  CAS  Google Scholar 

  68. Espinosa-de-los-Monteros A, de la Torre JI, Rosenberg LZ, Ahumada LA, Stoff A, Williams EH et al (2006) Abdominoplasty with total abdominal lipossuction for patients with massive weight loss. Aesthetic Plast Surg 30(1):42–46

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was partially supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), according to the process number 2006/53706-4.

Conflict of interest

None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article.

Author information

Authors and Affiliations

  1. School of Medical Sciences, Universidade de Marília (UNIMAR), Av. Rio Branco, 1132, Cj. 41, Alto Cafezal, Marília, SP, 17502-000, Brazil

    Luís Ricardo Martinhão Souto

  2. Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Caixa Postal 6111, Campinas, SP, 13083-970, Brazil

    Luís Ricardo Martinhão Souto, Elinton Adami Chaim & Rafael Cremonini Barbosa

  3. Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil

    Joyce Maria Annichino Bizzacchi

Authors
  1. Luís Ricardo Martinhão Souto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elinton Adami Chaim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rafael Cremonini Barbosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joyce Maria Annichino Bizzacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luís Ricardo Martinhão Souto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Souto, L.R.M., Chaim, E.A., Barbosa, R.C. et al. Increased Intraoperative Bleeding in Patients Undergoing Abdominoplasty After Gastroplasty is not Due to Coagulopathy. Aesth Plast Surg 36, 1283–1291 (2012). https://doi.org/10.1007/s00266-012-9976-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-012-9976-0

Keywords

Search

Navigation