Background and Objectives: Overweight patients meet obvious anatomical changes in the appearance of their skin and consequently morphological changes are expected. Weight loss in a massive manner results in redundancy of the skin following sleeve gastrectomy. The current work targeted to determine impact of morphological and morphoquantitative changes of epidermis, dermal fibers and endogenous stem cells (SCs) on surgical outcome in female patients with class III overweight and those with weight loss in a massive manner subjected to sleeve gastrectomy.
Patients and Methods: Skin biopsies were obtained from excised skin during surgical intervention in thirty female patients, classified into three groups (10 patients for each group). Normal weight group presented with history of no weight loss who have done abdominoplasty. Morbid obesity (MO) group who have done sleeve gastrectomy. Massive weight loss (MWL) group presented with history of massive weight loss after sleeve gastrectomy and were submitted to abdominoplasty. Skin specimens were taken during abdominoplasty after surgical excision of excess abdominal skin in 1st and 3rd groups and during sleeve operation from wound edge in the 2nd group. Sections were subjected to histologic, biochemical, Phenotypic, morphoquantitative studies and quantitative polymerase chain reaction (qPCR).
Results: Wound complications that occurred in MWL patients, were less in MO patients, and some of them required reoperation due to recurrence of redundancy. Associated phenotypic and morphometric changes in epidermal barrier, dermal fibers, degeneration marker and endogenous SCs were less evident in MO patients.
Conclusions: Patients presenting with MWL following sleeve gastrectomy should accept higher complication rates and revisional procedures for recurrent redundancy due to altered skin behaviour. The beneficial therapeutic outcome could be related to the plasticity of skin SCs to transdifferentiate into adult skin cells of epidermal barrier and dermal fibers responsible for skin integrity