מתוך medicontext.co.il
NEW YORK (Reuters Health) – Certain patients who are slightly overweight to moderately obese can safely have the equivalent of up to 17 liters (about 4.5 gallons) of fat suctioned from their body in a single operation, researchers report.
Large-volume liposuction had been previously associated with dangerous complications, such as excessive blood loss requiring blood transfusions. Other safety concerns include pulmonary edema.
But a new approach known as the "superwet" technique, in which surgeons inject fluids containing local anesthetic and vasoconstricting agents into fat prior to surgery, can reduce blood loss significantly, and is associated with an extremely low rate of complications.
For instance, before the superwet technique was adopted in the early 1990s, about 70% fat and 30% blood was removed, according to the report in the November issue of Plastic and Reconstructive Surgery. Now, the average mass contains 1% blood, 70% fat and 29% crystalloid solution.
"Advances in the understanding of physiology during liposuction and advances in surgical and anesthetic techniques have allowed greater and greater volumes to be removed at one setting," Dr. George W. Commons and colleagues from Stanford University in Palo Alto, California, conclude.
The findings are based on a review of 631 patients who underwent large-volume liposuction, performed by Dr. Commons, over 12 years. All patients had at least 3 liters of fat removed and the majority of patients had up to 10 liters of fat removed. Most patients (93%) were women and nearly all weighed within 50 pounds of their ideal weight, according to medical charts.
One year after surgery, about 80% of patients had maintained their postoperative weight. The majority of complications were minor, including skin injuries and burns and allergic reactions, but 4 patients (0.6%) developed mild pulmonary edema and 1 patient developed pneumonia. None of the patients required a blood transfusion or died from the surgery.
"The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed," Dr. Commons and colleagues conclude.
In an accompanying editorial, physicians from the University of Texas Southwestern Medical School in Dallas stress that liposuction is a procedure for patients who are healthy. Individuals with underlying medical problems or those who are obese are not candidates for the procedure, as Dr. Commons and colleagues make clear by their selection of patients, they note.
"Aside from being in good general health, patients must also have realistic expectations and be motivated to make necessary changes such as diet, exercise, and lifestyle alterations," write Dr. Rod J. Rohrich and colleagues.
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