Bauchdeckenstraffungen und Hidradenitis suppurativa (Acne inversa) bei Patienten nach massivem Gewichtsverlust

Zusammenfassung

Einleitung

Postbariatrische Operationen nach massivem Gewichtsverlust (MWL) sind mit erhöhten Minor- und Major-Komplikationen (17–55%) vergesellschaftet. Liegt zusätzlich eine langjährige Leidensgeschichte einer Hidradenitis suppurativa/Acne inversa (HS) im Unterbauch- und Leistenbereich vor, können infektionsbedingte Komplikationen in nahe 100% auftreten. Diese erfordern ein differenziertes prä-, intra- und postoperatives Therapieregime.

Material und Methoden

Von 2010 bis 2021 erfolgten bei n = 12 (Frauen n = 8 [66,6%], Männer n = 4 [33,3%]) entweder eine konventionelle (Pittsburg Rating Scale [PRS] Grad 2, n = 6) oder Fleur-de-Lis-(FDL-)Abdominoplastik (PRS Grad 3, n = 6) nach massivem Gewichtsverlust. Alle Patienten hatten gleichzeitig eine langjährige HS am Unterbauch/Leistenbereich (Hurley-Klassifikation Grad 2: n = 10, Grad 3: n = 2). Die Prävalenz lag bei 1,09%.

In einem Follow-up, das 12 Monate nach der Bauchdeckenstraffung erfolgte, wurden die postoperativen Minor- und Major-Komplikationen in Zusammenhang mit möglichen Risikofaktoren gebracht (Alter, Art der Gewichtsabnahme, Nikotinabusus etc.).

Ergebnisse

Das mittlere Alter betrug 45,2 Jahre (± 10,3), der mittlere BMI zur Operation 33,24 kg/m² (± 8,7), der durchschnittliche BMI-Verlust lag bei 19,01 kg/m² (± 5,9) und der maximale BMI vor Gewichtsabnahme zeigte 52,25 kg/m². Die Hidradenitis suppurativa bestand im Durchschnitt seit 31,5 Jahren, und n = 2 (16,6%) hatten aktuell eine medikamentöse Therapie dagegen. Bei allen Patienten lagen noch weitere Lokalisationen am Körper vor und bei 66,6% erfolgte bisher mindestens eine operative Behandlung der HS. Nikotinabusus bestand aktuell bei 42,0%. Die durchschnittliche Operationszeit lag bei 98 min und die mittlere Resektatmenge betrug 2210 g. Die allgemeine Komplikationsrate betrug 83,0% (n = 10). Von den 12 Patienten hatten 8 Major-Komplikationen mit erneuter Operation in Narkose. Keiner hatte ein infiziertes Hämatom, keiner einen Abszess/Infektion und keiner eine akute Nachblutung innerhalb von 24 h postoperativ.

Schlussfolgerung

Schwere infektionsbedingte Weichteilkomplikationen, wie sie nach gängiger Meinung zu erwarten wären, traten bei keinem der Patienten mit dem von uns vorgestellten Antibiotikaregime auf. Eine Inspektion der Bauchdecke und Leistenregion 4 Wochen vor dem geplanten Eingriff ist empfehlenswert, um ggf. präoperativ eine Therapie der HS einzuleiten.

Abstract

Introduction

Post-bariatric surgical procedures in patients after massive weight loss (MWL) are often associated with elevated minor and major complications (17–55%). If there is additionally a long history of hydradenitis suppurativa (HS) in the lower abdomen and groin area, complications of infection can appear in all patients. Differentiated pre-, peri- and postoperative therapy regime is then indicated.

Materials and Methods

From 2010 to 2021, a total of 12 (66.6% women, 33.3% men) consecutive patients underwent conventional (Pittsburg rating scale [PRS]: Grade 2) or fleur-de-lis abdominoplasty (PRS: Grade 3) after massive weight loss. All patients simultaneously suffered long term HS in the lower abdomen and groin area (Hurley classification Grade 2: n = 10, Grade 3: n = 2). The prevalence in our study was 1.09%.

Postoperative minor and major complications (follow-up 12 months) are determined and correlated with risk factors (e.g. age, method of weight loss, nicotine abuse…).

Results

Mean age was 45.2 years (± 10.3), mean BMI pre-operative 33.24 kg/m² (± 8.7), the mean decrease in BMI was 19.01 kg/m² (± 5.9) and the maximum BMI before weight loss 52.25 kg/m². The mean duration of the suppurative hydradenitis was 31.5 years and n = 2 (17.0%) had current medical therapy against this. All patients showed further locations of the HS in other parts of the body and 66.6% had had surgical procedures because of the HS. 42.0% had nicotine abuse. The mean operation time was 98 minutes and the mean resection weight was 2210 grams. The overall complication rate was n = 10 (83.0%), and the rate of major complications n = 8 (66.4%) with surgical intervention in full anaesthesia. No patient had an infected haematoma, abscess or acute bleeding in the first 24 hours postoperatively.

Conclusion

The antibiotic regime prevented the expected soft tissue infection in all patients. Inspection of the abdomen and groin area 4 weeks before surgery is recommended, in order to start preoperative therapy for the HS.

Schlüsselwörter

Akne inversa - Adipositaschirurgie - Bauchdeckenplastik - Antibiotikatherapie

Keywords

Acne inversa - obesity surgery - antibiotic treatment - abdominoplastic

Publication History

Received: 09 February 2023

Accepted after revision: 12 June 2023

Article published online:
20 July 2023

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