Lipedema after Bariatric and Metabolic Surgery: A Scoping Review

Area of Science:

• Medical Science
• Surgical Oncology
• Obesity Medicine

Background:

• Lipedema is frequently undiagnosed in obese patients, leading to treatment challenges.
• Patients undergoing bariatric surgery may experience persistent limb pain and minimal extremity circumference reduction despite weight loss.
• This review addresses diagnostic challenges and clinical outcomes of lipedema in patients after metabolic bariatric surgery.

Purpose of the Study:

• To systematically review patient characteristics, clinical outcomes, and diagnostic challenges of lipedema in patients undergoing metabolic bariatric surgery.
• To identify current practice gaps and promote earlier diagnosis and tailored treatment for lipedema.
• To explore the impact of bariatric surgery on lipedema symptoms.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Embase, Medline, and Cochrane databases.
• Inclusion criteria encompassed original articles, case reports, and case series focusing on lipedema post-metabolic bariatric surgery.
• Data were collected up to December 19th, 2023.

Main Results:

• The review included 49 female patients diagnosed with lipedema, with a mean age of 42.43 years and mean BMI of 49.92 kg/m².
• Sleeve gastrectomy was the most common procedure (51%), followed by Roux-en-Y gastric bypass (45%).
• Despite significant excess weight loss (mean 70.93%), mean pain scores slightly increased post-surgery, indicating limited improvement in lipedema-related symptoms.

Conclusions:

• Early recognition of lipedema in females with disproportionate fat distribution and extremity pain is critical.
• Current evidence suggests bariatric surgery alone does not significantly improve lipedema symptoms or associated pain.
• Further research and tailored treatment strategies are needed for effective lipedema management in this patient population.