Surgical treatment of regional adiposity. Lipectomy versus surgically induced weight loss.

Recognition of abdominal fat distribution as a significant risk factor raised the question whether surgical treatment of regional adiposity might be feasible or desirable. This is a review of cosmetic and therapeutic lipectomy in man and experimental lipectomy in rodents examining morphologic and metabolic aspects as well as conditions for growth and regrowth of adipose tissue. Potentially detrimental metabolic effects of lipectomy are discussed in the context of the "metabolic sink" hypothesis. Data are also presented on the distribution of weight loss after gastrointestinal surgery for morbid obesity. An obesity-related "elephantiasis" syndrome in superobese men is described. "Giant lipectomy" in one such case, removing a record 50 kg during one operation, with pre- and postoperative determination of body fat is reported. It is concluded that lipectomy is not a treatment for obesity with very rare exceptions. Regrowth of adipose tissue is possible under special circumstances. Surgically induced massive weight loss does not seem to cause preferential regional weight loss, though risk-reducing beneficial metabolic effects are achieved after gastrointestinal obesity surgery.