State of lipid and carbohydrate metabolism after liposuction

The dissertation examines the state of lipid and carbohydrate metabolism in patients after liposuction. The author considers liposuction not only as an aesthetic operation, but also as a possible method of body weight reduction in the combined therapy of obesity. The study is aimed at assessing the dynamics of lipid metabolism parameters, leptin levels, and carbohydrate metabolism in the postoperative period, as well as at identifying factors that allow the effectiveness of the intervention to be predicted. The practical significance of the work is associated with the broadening of indications for liposuction and the prevention of diseases linked to obesity.

RELEVANCE OF THE TOPIC. The pursuit of beauty has always been inherent in human beings. In modern society, a slender and toned figure is regarded as the ideal of an attractive body. Sports activities, diets, and various cosmetic procedures do not always make it possible to achieve the desired result. In this regard, aesthetic operations for body contour correction are becoming increasingly popular (Belonogov L.I., 2001). Liposuction is rightly considered the most popular method of surgical body contour correction. The wide dissemination of the method is due to the short rehabilitation period, the absence of visible skin scars, and the lasting aesthetic result (Malakhov S.F., Belonogov L.I., 2001). In recent years, the indications for liposuction have expanded considerably. New techniques have been developed that make it possible to perform liposuction in patients with substantial fat deposits — so-called megaliposuctions, in which the volume of aspirate is 10 litres or more (Fournier P.F., 1991, 1996; Greco R.J., 1997). The simultaneous removal of a significant amount of adipose tissue cannot but affect carbohydrate and fat metabolism (Pavlyuk-Pavlyuchenko L.L. et al., 1999). Nevertheless, in such operations, medical monitoring of operated patients ends with their discharge from the hospital or in the immediate postoperative period, while possible metabolic changes in the late postoperative period remain outside the field of view of both the physician and the patient. According to the literature, studies on this problem are limited to determining the dynamics of blood lipids in the immediate postoperative period (Ivanchenkova T.A., Vissarionov V.A., 2005) and to studying certain parameters of lipid and carbohydrate metabolism after excision of adipose tissue in experiment (Pavlyuk-Pavlyuchenko L.L. et al., 1999; Vandeweyer E., 2002). All this determined the relevance of the undertaken study.

AIM OF THE WORK: on the basis of the study of changes in lipid and carbohydrate metabolism in the postoperative period, to determine the role of liposuction in body weight reduction.

To achieve this aim, the following tasks were set:

1. To investigate the effect of liposuction on the state of lipid metabolism.

2. To determine the change in carbohydrate metabolism after the removal of adipose tissue.

3. To assess the dynamics of leptin levels after liposuction.

4. On the basis of the data obtained, to determine the possibility of using liposuction for body weight reduction.

SCIENTIFIC NOVELTY. Data have been obtained that make it possible to consider liposuction as a method that activates antiatherogenic processes. It has been established that the removal of excess fat deposits is accompanied by an initial decrease in the concentration of leptin in blood plasma, which influences the eating behaviour of patients. It has been proved that the operation is especially effective in patients with an initially lower insulin level.

PRACTICAL SIGNIFICANCE. The introduction of the research results into clinical practice makes it possible to broaden the indications for liposuction not only as an aesthetic operation, but also enables the method to be used for body weight reduction in the combined treatment of obesity; it can be applied for the prevention of diseases associated with obesity (coronary artery disease, diabetes mellitus) and allows the outcomes of treatment to be predicted.

MAIN STATEMENTS SUBMITTED FOR DEFENCE.

1. Surgical removal of adipose tissue activates lipolytic and antiatherogenic processes in the body.

2. Liposuction activates glycolytic processes and leads to a decrease in blood glucose levels in the postoperative period.

3. Liposuction affects the regulation of eating behaviour. The method can be used for body weight reduction in the combined treatment of obesity.

4. An initially low insulin level (up to 18 μIU/ml) makes it possible to predict body weight reduction after liposuction.

THE AUTHOR'S PERSONAL CONTRIBUTION TO THE STUDY. The author's contribution consisted in defining the main idea of the research, personally performing therapeutic and diagnostic procedures, carrying out the statistical processing of the material, and analysing the results obtained.

APPROBATION OF THE WORK. Based on the main results of the dissertation research, reports were delivered at a scientific and practical conference dedicated to the 120th anniversary of the founding of SPb MAPO, Saint Petersburg, 24-25 February 2005; at the II International Congress on Aesthetic Surgery and Medicine, Germany, Lindau, 11-13 June 2006; and at the international conference "New Developments in Plastic Surgery and Combustiology," dedicated to the 10th anniversary of the establishment of the Department of Plastic and Aesthetic Surgery of SPb MAPO, Saint Petersburg, 25-28 May 2007.

IMPLEMENTATION OF THE RESEARCH RESULTS. The results of the study have been implemented in the practical work of the Clinic of Plastic and Aesthetic Surgery of SPb MAPO and the surgical department of the LLC "Clinic of Aesthetic Surgery and Cosmetology," and are used in the educational process during classes with trainees and clinical residents of the Department of Plastic and Aesthetic Surgery of SPb MAPO.

PUBLICATIONS. On the topic of the dissertation, 4 scientific works have been published, including 1 article in a journal recommended by the Higher Attestation Commission of the Russian Federation.

STRUCTURE AND VOLUME OF THE DISSERTATION. The dissertation is set out on 107 pages of typewritten text and consists of an introduction, 5 chapters, a conclusion, findings, and a list of references comprising 193 sources, of which 106 are by foreign authors. The work is illustrated with 14 tables and 31 figures and graphs.