Reliability of a Vertical Reconstruction of the Abdomen Following Massive Weight Loss

The size and shape of a patient's abdomen after massive weight loss (MWL) vary according to the extent and pattern of abdominal fat distribution. The panniculus adiposus results from a combined pull of heavy fat on the skin and the weakening of the connective tissue, creating an irreversible sagging and ptotic abdomen with several folds. Reconstruction aims to reverse the topographic anatomical changes caused by underlying pathology of central abdominal fat. This study aimed to illustrate the burden of central abdominal fat pathology after MWL and evaluate a reconstructive surgical solution termed central angiosome vertical abdominoplasty (CAVA).

This retrospective cohort study included patients who underwent surgery using the CAVA method from August 2019 to August 2024. Inclusion criteria were physical burden and medical morbidity caused by abdominal skin and residual fat after MWL. Patient charts were reviewed for preoperative health status, including weight loss, comorbidities, and operative and postoperative information.

The study included 25 patients, aged 31-66 years, with varying degrees of weight loss. Most patients achieved weight loss through bariatric surgery. The average operative time was 150 minutes, and the resection weight ranged from 553 to 17,680 g. Complications were mostly minor, with 2 patients requiring readmission.

The CAVA technique is designed to remove central abdominal pathology and reconstruct the abdominal wall using displaced, adjacent tissue. A focus on central abdominal resection with midline reconstruction offers a viable solution for patients burdened by central abdominal pathology after MWL.