Body Contouring Has Minimal Sustained Weight Loss Impacts, Study Says

Karim Sarhane
Dr. Karim Sarhane

Body contouring helps patients who have experienced significant weight loss because of diet, post-pregnancy weight, and bariatric surgery tighten loose and saggy skin. A study published in the American Society of Plastic Surgeons’ June 2023 issue of the journal Plastic and Reconstructive Surgery reported that body contouring has long-term impacts on weight loss for people who have it after bariatric surgery. Those who undergo body contouring can immediately see improvements. Sometimes, skin condition improvements are immediately compared to non-surgical options that might take longer. Incidentally, most common body contouring procedures focus on the thighs, arms, back, belly and flanks, buttocks, neck, and skin. Most studies on the effectiveness of this procedure in encouraging long-term weight loss are mixed. This study, however, focused on 2,531 patients who underwent bariatric surgery from 2009 to 2012 and saw small gains in long-term weight loss. Researchers separated the patients into three groups. The first group of 350 patients had body contouring a median of two years after bariatric surgery. The second group comprised 364 patients who participated in a consultation about body contouring but did not follow through with the procedure. Finally, 1,817 patients neither had the surgery nor the consultation. Researchers found that those who had the body contouring did experience more sustained weight loss than those who did not have the procedure using body mass index (BMI) as a measure. BMI measures how much fat is in the body and is calculated by taking a person’s weight in kilograms and dividing it by their height in meters squared. The study found that those who underwent body contouring after a year had a lower average body mass index (BMI) than those who elected not to have the surgery. Seven years later, patients with the body contouring procedure saw their BMI reduced even further to 5kg/m2, on average. Interestingly, patients who sat for a body contouring consultation but did not undergo the procedure also saw positive impacts. One year after their bariatric procedure, their BMI was, on average, 1.5 kg/m2 lower compared to those who had no consultation. After seven years, their BMI was, on average, 2.3 kg/m2 lower than those who did not have a consultation. In addition, the study compared patients with body contouring with 259 patients in the consultation group who experienced enough weight loss to qualify for a consultation. After seven years, the study found that each group had a comparable BMI, with the body contouring procedure group having an average BMI of 31 kg/m2 compared to the consultation group with a BMI of 30 kg/m2. Incidentally, those who did not have the consultation or the contouring procedure had an average BMI of 35 kg/m2. However, the study mentioned that researchers found that the type of bariatric surgery and the patient’s race impacted weight loss long-term. Those who had sleeve gastrectomy (involving several small incisions in the upper abdomen) sustained a lower BMI than those who had gastric bypass surgery, with the former experiencing an eight percent difference in weight loss on average after seven years. Also, African American patients experienced a lower sustained weight loss than other racial groups. Ultimately, researchers concluded that while those who had the surgery or participated in a consultation saw improvement, the impact on body contouring was minimal. They also said that body contouring impacts were secondary to individual factors improving body weight loss outcomes.

Karim Sarhane, MD

Karim Sarhane

ACS Operation Giving Back Focuses on Africa

Karim Sarhane
Dr. Karim Sarhane

The American College of Surgeons (ACS) aims to improve surgical care globally. Its Operation Giving Back (OGB) initiative allows surgeons to volunteer their time in places where their skills are needed. In 2023, the ACS OGB program announced volunteer opportunities, including launching a fellowship allowing surgeons to travel to Hawassa University in Ethiopia. In August 2022, the OCG program, the Virginia Commonwealth University Health System Authority, the University of Utah School of Medicine, and Hawassa University College of Medicine and Health Sciences established the Academic Global Surgery Fellowship Program. This fellowship opportunity builds on an earlier effort launched by the OCG program and Hawassa University College of Medicine. The joint effort between the OCG and the Hawassa College of Medicine program began in 2018 in the College of Surgeons East, Central, and Southern Africa (COSECSA) region. This program has focused on improving surgical and clinical services, quality improvement programs, and research at Hawassa University Hospital in Ethiopia, a country with a population of over 18 million people. The Academic Global Surgery Fellowship Program will facilitate multidisciplinary and interdisciplinary partnerships focusing on research, education, and surgical training. University of Utah or Virginia Commonwealth University students were selected for the fellowship opportunity. These fellows received an appointment for one year, where they will be involved with research, conducting educational and quality improvement programs, sharing data and results with the medical community, generating academic research, and gaining from mentoring opportunities at Hawassa University Hospital. The fellowship fosters a lasting relationship between the US and Ethiopia programs. Fellows will travel to Ethiopia during the appointment period for three to six months and can participate in advocacy programs if they wish. All this work culminates in the fellow presenting their research at conferences and their conclusions in the end-of-year report. Dr. Girma Tefera, director of ACS OGB, stated that this fellowship is an opportunity for medical professionals entering surgical fields to participate in research and quality research at the Hawassa University Hospital. It also presents opportunities to close healthcare gaps and to give Africans access to quality surgical care. The launch of the fellowship program in 2022 was one of many works the OGB program was involved in Africa. In April 2023, the OGB program partnered with COSECSA to volunteer to oversee COSECSA fellowship oral exams, equivalent to the American Board of Surgery oral exam for certification. Medical residents can take the oral exams after completing at least five years of postgraduate training (six years for neurosurgery), meeting all COSECSA course requirements, and passing the COSECSA written exam. Upon completing all these requirements, graduates receive the Fellowship of College of Surgeons designation, recognized in all COSECSA member countries numbering 14. This joint effort is part of an overall initiative between ACS and COSECSA to improve healthcare in Sub-Saharan Africa. Outside of volunteering as examiners, the two organizations have joined efforts to spearhead the ACS-COSECSA Surgical Training Collaborative, one of its most extensive efforts. This ACS partnership is a part of the OGB initiative, which involved gathering ACS resources and that of multiple US hospital departments of surgery to increase the number of surgical trainees that train in Africa. The team established the first training site in Hawassa University Hospital in 2018. Since then, the collaboration has launched a second training hub at University Teaching Hospital in Lusaka, Zambia, in 2020.

Karim Sarhane, MD

Karim Sarhane

ACS Says, AI Offers Surgical Benefits for Healthcare Organizations

Karim Sarhane MD
Dr. Karim Sarhane

A physician for more than 12 years, Karim Sarhane, MD, is a General and Advanced Laparoscopy at the Burjeel Royal Hospital in Abu Dhabi, United Arab Emirates. In addition to his role as a surgeon, Dr. Karim Sarhane is a fellow with the American College of Surgeons (ACS). The organization seeks to improve the quality of surgical care. A June 2023 ACS press release reported that AI has positive outcomes for surgical care. Using algorithms as a part of AI will allow healthcare organizations to manage a vast amount of data. More significantly, the article mentioned the different ways that AI, and the algorithms used with it, will make surgery and healthcare organizations run more efficiently. The technology can help surgeons to estimate how long it’ll take to complete procedures. It also will allow them to organize hospital bed availability better. Also, AI’s ability to integrate information will enhance surgical decision-making because the information is in one place, whether on the operating table or at the patient’s bedside. The latest surgical guidelines, research insights, and the patient’s charts are all within reach. Finally, chatbots can assist patients who have questions after surgery. This particular tool allows healthcare organizations to use nurses more productively.

Karim Sarhane, MD

Karim Sarhane
Karim Sarhane

A Comparison of Laparoscopic and Open Surgery

Karim Sarhane
Dr. Karim Sarhane

Surgeons utilize two distinct methods for diverse surgical interventions: laparoscopic and open surgery. It is important for preoperative patients to understand these treatment alternatives, including the surgical processes, benefits and drawbacks, and ensuing discomfort after operation. While clinicians are the ideal experts to determine the preferred surgical approach, patients’ comprehension of the two techniques enables meaningful treatment decisions. Laparoscopic or keyhole surgery involves a small abdominal incision of less than one centimeter. Through this opening, a laparoscope (a slender instrument equipped with a high-resolution camera) is introduced to enable visualization of the body’s internal structures without the need for open surgery. Surgeons then use a magnified view on a video monitor to perform the procedure. Various surgeries can be performed laparoscopically, including abdominal procedures to treat Crohn’s disease or inflammation of the colon, rectal prolapse (where а part of the rectum sticks out), chronic constipation, and duodenal perforation (holes in the intestine). Other surgeries that can be performed laparoscopically include gallbladder procedures, gynecological surgeries, and hernia surgeries to repair weak tissues in the abdomen. Laparoscopic surgeries are characterized by their minimally invasive nature, resulting in decreased pain, blood loss, and surgical trauma. The approach also reduces postoperative complications, promotes faster wound healing, and minimizes the duration of hospital stays. Less exposure to internal organs also reduces risks for external contaminants. That being said, trocar or instrument insertion, a key process in laparoscopic surgery, may lead to abdominal wall hematoma or bleeding, as well as umbilical hernia characterized by bulging tissue around the navel region. In some cases, doctors may recommend against laparoscopic surgery due to factors such as prior surgery in the area or excessive weight, which can impede surgical access and visibility. Emergency open access may be necessary in cases of significant bleeding or infection. Additionally, individuals with certain cardiopulmonary conditions may be at a higher risk of negative reactions to compounds like carbon dioxide used during laparoscopic procedures. Open surgery may be a safer alternative in these scenarios. Open surgery, a time-honored approach to surgical procedures, involves using a scalpel to make а large incision up to 10 inches in length on the skin to reach the intended surgical area. This technique provides surgeons with access to sizeable organs and facilitates the performance of intricate procedures like heart surgery, organ transplantation, and the elimination of kidney stones. Compared to laparoscopic surgery, open surgery is good for treating conditions like large tumors, complex fractures, and spinal tumors or severe scoliosis, which minimally invasive approaches cannot address. Open surgery also affords surgeons a clearer view of the operative site, facilitating more efficient tissue and organ manipulation. That being said, due to the need for extensive incisions, this type of surgery mаy cause increased post-operative discomfort, complications, and prolonged healing periods. Medical costs depend on several variables, such as the type of procedure, the patient’s medical history, and the health care facility. Typically, laparoscopic surgery incurs а higher cost due to additional equipment expenses. However, the quick recuperation and shorter hospital stay associated with laparoscopic surgery can offset costs. In the same vein, open surgery may seem cheaper at first glance, but а prolonged hospital stay and greater likelihood of complications may ultimately increase expenses. Patients should carefully weigh various factors when choosing between laparoscopy and open surgery. Consulting a medical professional is crucial to understand the nuances of one’s unique medical situation, rather than simply relying on personal judgment or non-expert opinions. A skilled surgeon will evaluate each patient before making recommendations, empowering them to make well-informed decisions.

Karim Sarhane, MD

Karim Sarhane

Karim Sarhane

Benefits of Robot-Assisted Surgery

Karim Sarhane
Dr. Karim Sarhane

Surgical robots have transformed how surgeons deliver medical solutions. Robot-assisted surgery allows doctors to perform complex surgical procedures faster and with more precision and control than was previously possible with conventional surgical techniques. Today, many surgeons frequently use robot-assisted surgery for various medical procedures. Among others, robotic surgery is used by general surgeons, urologists, gynecologic surgeons, colorectal surgeons, and cardiothoracic surgeons. Also known as robotic surgery, robot-assisted surgery comes with numerous benefits for both the patient and the surgeon. Doctors, through robotic technology, make tiny incisions that allow complex surgical procedures. Surgical robots are computer-controlled, self-powered devices programmed to aid surgeons in the positioning and manipulation of surgical instruments. During the procedure, three to four tiny robotic arms are inserted through a small incision on the patient’s body. One robotic arm holds a small camera while two arms assume the role of a surgeon’s hands. A fourth arm may help move tissue out of the way. Through a small console, the physician controls the robotic arms with a standby surgical team nearby for any needed assistance during the procedure. Because the robot’s “hands” are very dexterous, surgeons can operate in very tight body spaces that they would normally find very challenging to access through open surgery. The robotic arm’s reach is also greater than that of a human hand. In addition, robotic arms can rotate and maneuver the small surgical instruments in tight spaces in ways human hands cannot. A sophisticated high-definition camera provides enlarged 3D views of the surgical area that a human eye couldn’t possibly generate. Robot-assisted surgery is a great option when the surgeon needs to access hard to reach parts of the body. The tiny surgical instruments help avoid the necessity of the large incisions made when using conventional surgical tools. Since robotic surgery involves the use of smaller instruments, it becomes much easier to navigate around healthy tissue or organs. This reduces the potential impact the surgery can have on the patient’s body, as less tissue is touched or damaged. It also contributes to less pain and a more comfortable recovery journey. Robotic surgery is considered minimally invasive, and compared to conventional surgery tends to have a shorter recovery period. However, because people are very different, the healing times will of course vary for the same procedure. Also, patients can save on the cost of hospital stays, since most robot-assisted surgeries can be performed on an outpatient basis, which also saves time. Because of the greater precision and smaller incisions, the chances of surgical site infection are also reduced. Smaller incisions may also mean less bleeding and swelling after surgery. This can translate to requiring less pain-relieving medication that is typically associated with conventional surgery. Compared to conventional surgery, incidences of a patient requiring a blood transfusion or experiencing major complications after robot-assisted surgery are generally much fewer. However, it’s important to point out that robot-assisted surgery may not be an option for every procedure or patient. The suitability of the procedure will depend on the particular medical case. Therefore, patients should talk with their healthcare providers about the benefits, risks, and how robot-assisted surgery compares with conventional open surgery and other minimally invasive surgery options.

Karim Sarhane, MD

Karim Sarhane

Karim Sarhane

An Overview of Laparoscopic Surgery

Karim Sarhane
Dr. Karim Sarhane

Laparoscopic surgery is a revolutionary surgical technique that utilizes innovative methods to deliver improved surgical outcomes. Through the insertion of short, narrow tubes known as trochars into the abdomen via small incisions, this procedure paves the way for transformative medical possibilities. Surgeons skillfully employ long and narrow instruments within these trochars to manipulate, cut, and suture tissue, granting them great precision. In stark contrast to traditional open abdominal surgery, which necessitates substantial incisions ranging from 6 to 12 inches, laparoscopic surgery embraces a more precise approach. With a mere two to four small incisions measuring half an inch or less, the benefits can be substantial. This technique allows for enhanced visualization and optimal surgical maneuvers. These incisions serve distinct purposes: one acts as an entry point for a camera, while the others accommodate the surgical instruments. A vast array of common surgeries can now be accomplished through laparoscopy, heralding a new era of medical advancement. The procedure entails using a laparoscope, a slender tube equipped with high-intensity light, and a high-resolution camera at its forefront, granting doctors a clear view of the abdominal organs. Guided by these live images projected onto a video monitor, physicians gain invaluable information without resorting to extensive incisions. Moreover, they can extract biopsy samples and perform surgical interventions, all during the same procedure. Eligibility for laparoscopic surgery hinges upon the complexity of an individual’s condition. This technique is rapidly emerging as the preferred choice for an expanding range of common operations, driven by its cost-effective nature and improved patient outcomes. Doctors now recommend laparoscopy to examine various organs, including the liver, appendix, stomach, gallbladder, pancreas, spleen, small and large intestines, and reproductive organs. Exceptional advantages associated with laparoscopic surgery include reduced bleeding, accelerated healing, and diminished pain and scarring. Unlike standard open surgery, recovery time after laparoscopic surgery can be remarkably reduced from several weeks to a few days. A vital aspect contributing to these favorable outcomes is the minimal manipulation of abdominal contents during laparoscopic procedures. Before undergoing most laparoscopic surgeries, patients typically receive general anesthesia. Adequate preparation is vital, and doctors typically advise patients to abstain from eating or drinking for approximately eight hours before the procedure to minimize the risk of anesthesia-induced nausea. In addition, it’s essential to arrange for a reliable means of transportation home considering the potential disorientation resulting from the anesthesia’s effects. Specific instructions regarding medications may also be provided by the attending physician. While laparoscopy generally carries a low-risk profile, it is important to remain vigilant for any potential complications. Although rare, instances of bleeding, infection, or organ damage may occur. If symptoms such as fevers or chills, escalating abdominal pain, redness or discoloration, bleeding, and shortness of breath persist, consult the doctor. Other signs that might warrant a doctor’s attention include swelling, bleeding, continuous nausea or vomiting, inability to urinate, or lightheadedness. There is a minor threat of organ injury during a laparoscopy, which might result in the leakage of blood or other fluids into the body if an organ is accidentally pierced. In such circumstances, additional surgical intervention is required to repair the damage and restore function. Less prevalent risks of laparoscopic surgery include issues from general anesthesia, inflammation of the abdominal wall, and the formation of blood clots that could spread to the pelvis, legs, or lungs. While these dangers are rare, it is critical to be aware of them and get proper medical assistance if any of these symptoms occur.

Karim Sarhane, MD

Karim Sarhane

Differences between a Panniculectomy and a Tummy Tuck

Karim Sarhane
Dr. Karim Sarhane

Weight loss helps address health issues like the risk of congenital conditions and can boost self-esteem due to body contouring. The loss, however, can result in loose and sagging skin that does not respond to exercise, and may require removal through surgery to enhance the contouring further. Two primary surgical options exist – panniculectomy and tummy tuck. The choice between the two may be confusing. Though the end goal remains the same, there are differences in the process, candidates, cost, and risks. A panniculectomy involves removing the panniculus, the excess loose skin that forms a flap below the waistline and over the thighs. The panniculus does not emanate from pregnancy, excess weight, or regular weight loss. It emanates from losing excess body weight, typically over 100 pounds, mostly from extensive weight loss procedures like gastric bypass. The extent of a panniculectomy, considered a medical procedure, depends on how much skin is removed. A tummy tuck, on the other hand, is considered a cosmetic procedure that involves removing excess stomach skin and tightening the abdominal muscles. Sometimes surgeons add an abdominal mesh to reinforce muscle repair. This woven mesh surgically temporarily or permanently supports organs after surgery or damaged tissue during healing. The second difference between a panniculectomy and a tummy tuck is eligibility. The former is best for patients with life-impacting sagging skin, which follows heavy weight loss, especially gastric bypass. Other candidates include individuals experiencing hygiene issues under the skin such as ulcers and infections, especially below the pubic region. The excess skin flap can also affect the individual’s mobility. On the other hand, a tummy tuck addresses sagging skin that does not affect the individual’s health and is mainly for cosmetic purposes, especially contouring the body for a more hourglass shape. Other good fits include individuals with sagging skin following a pregnancy who cannot get rid of the excess skin despite exercise and diet changes. In conjunction with liposuction, a tummy tuck can help resolve body-related self-esteem issues and those seeking to get rid of more skin after a panniculectomy. The third difference is the recovery time after each procedure. Recovery from any mild to major surgery involves surgical drains, skin glue, steri-strips, and the dressing. The surgeon provides instructions on how to care for each over the recovery period. A panniculectomy typically takes eight weeks to heal. However, the time may vary depending on the surgery’s extent and the patient’s attendance to the wound after the surgery, especially daily tasks and nutrition. Even weeks after the healing has taken place, however, the patient should refrain from strenuous activities like heavy lifting. Tummy tucks take less time to recover from due to less surgery complexity – usually four to six weeks. With proper care, especially hygiene of the surgical area, the patient should resume regular activity, including strenuous tasks, in the first few weeks following the procedure. Due to the extent of the surgery, panniculectomies are more costly than tummy tucks. A procedure typically costs between $8,000 and $15,000, plus additional fees like anesthesia, compared to an average of $6,000 for a tummy tuck. However, as a medical procedure, insurance companies may cover part or all of a panniculectomy. There is also the cost of taking time off work, especially for self-employed individuals – patients should set aside a minimum of eight weeks for recovery, compared to four to six weeks for a tummy tuck. Finally, the risks and side effects differ. Although both procedures cause discomfort and pain, the side effects tend to be more severe for panniculectomy. These can include pain post-surgery, fluid retention, and numbness. Other effects, though rare, include chest pain, heart palpitations, shortness of breath, and infections. Conversely, tummy tuck patients may experience bruising, numbness, deep vein thrombosis, and bleeding around the surgical area.

Karim Sarhane, MD

karim sarhane