Panniculectomy Group Research Articles

Impact of panniculectomy in complex abdominal wall reconstruction: a propensity matched analysis in 624 patients.

In complex abdominal wall reconstruction (AWR), the role of concomitant panniculectomy has been debated due to concern for increased wound complications that impact outcomes; however, long-term outcomes and quality of life (QOL) have not been well described. The aim of our study was to evaluate the outcomes and QOL in patients undergoing AWR with panniculectomy utilizing 3D volumetric-based propensity match. A prospective database from a tertiary referral hernia center was queried for patients undergoing open AWR. 3D CT volumetrics were analyzed and a propensity match comparing AWR patients with and without panniculectomy was created including subcutaneous fat volume (SFV). QOL was analyzed using the Carolinas Comfort Scale. Propensity match yielded 312 pairs, all with adequate CT imaging for volumetric analysis. The panniculectomy group had a higher BMI (p = 0.03) and were more likely female (p < 0.0001), but all other demographics and comorbidities were similar. The panniculectomy group was more likely to have undergone prior hernia repair (77% vs 64%, p < 0.001), but hernia area, SFV, and CDC wound class were similar (all p > 0.05). Requirement of component separation (61% vs 50%, p = 0.01) and mesh excision (44% vs 35%, p = 0.02) were higher in the panniculectomy group, but operative time were similar (all p ≥ 0.05). Panniculectomy patients had a higher overall wound occurrence rate (45% vs 32%, p = 0.002) which was differentiated only by a higher rate of wound breakdown (24% vs 14%, p = 0.003); all other specific wound complications were equal (all p ≥ 0.05). Hernia recurrence rates were similar (8% vs 9%, p = 0.65) with an average follow-up of 28months. Overall QOL was equal at 2weeks, and 1, 6, and 12months (all p ≥ 0.05). Despite panniculectomy patients and their hernias being more complex, concomitant panniculectomy increased wound complications but did not negatively impact infection rates or long-term outcomes. Concomitant panniculectomy should be considered in appropriate patients to avoid two procedures.

Abdominal skin tensile strength in aesthetic and massive weight loss patients and its role in ventral hernia repair

BackgroundClarifying the biomechanics of abdominal skin could lead to different uses for this tissue such as the ventral repair of hernias in patients with excess skin and incisional hernias. The objective of this study was to compare the maximum tensile strength of abdominal skin to commercial meshes and to verify whether or not it varies between aesthetic patients and massive weight-loss patients.MethodsExperimental cross-sectional study. Skin samples sized 32 × 20 mm were taken from 15 abdominoplasties and 10 panniculectomies. The skin specimens were analyzed in vertical and horizontal tensile strength tests. Results were compared between the two groups including their traction directions. Commercial meshes were also tested. The results were analyzed using the Generalized Estimating Equation.ResultsThe maximum tensile strength supported vertically by abdominal dermis was 403.5 ± 27.4 N in the abdominoplasty group and 425.9 ± 33.9 N in the panniculectomy group. Horizontally, the values were 596.5 ± 32.2 N and 612.5 ± 43.9 N respectively. The strengths between traction directions were significantly different (p < 0.001). There were no differences between the groups with regard to the maximum tensile strength (p = 0.472). Tested commercial meshes had the following values: polypropylene 104.6 N, low-weight polypropylene 54.4 N, polytetrafluorethylene (PTFE) 82.2 N, and hydrated porcine small-intestinal submucosa 60.0 N.ConclusionIn our study, the tensile strength of the tested human abdominal dermis samples, both aesthetic and post-bariatric, was superior to the commercial meshes. Therefore, in selected cases, abdominal dermis could be an alternative tool in abdominal reconstruction during panniculectomies with concomitant hernia repair.

Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction: A Propensity Score Analysis.

Studies of abdominal wall reconstruction with concurrent panniculectomy have reported contradictory results. The authors hypothesized that patients undergoing abdominal wall reconstruction with concurrent panniculectomy experience more wound healing complications but similar rates of hernia recurrence compared with abdominal wall reconstruction alone. Of 548 consecutive patients, 305 patients (55.7 percent) underwent abdominal wall reconstruction alone and 243 (44.3 percent) underwent abdominal wall reconstruction with concurrent panniculectomy. Mean follow-up was 30 months. The authors compared these two groups' postoperative complications and outcomes before and after propensity score analysis. Abdominal wall reconstruction with concurrent panniculectomy patients had a significantly higher overall complication rate (38.3 percent versus 29.2 percent; p = 0.025) and a trend toward a higher surgical-site occurrence rate (27.6 percent versus 20.7 percent; p = 0.06) compared with abdominal wall reconstruction alone. There were significantly higher incidences of skin dehiscence (19.3 percent versus 12.5 percent; p = 0.032), fat necrosis (10.7 percent versus 3.6 percent; p = 0.002), and infection abscess (9.5 percent versus 4.3 percent; p = 0.023) but no significant difference in hernia recurrence (6.9 percent versus 11.5 percent; p = 0.27) at long-term follow-up. Propensity score analysis yielded 188 pairs of matched patients with no significant differences in overall complication and hernia recurrence rates. Significantly higher rates of fat necrosis (9.6 percent versus 4.3 percent; p = 0.041) and abscess (10.1 percent versus 3.2 percent; p = 0.007) were observed in the abdominal wall reconstruction with concurrent panniculectomy group. Abdominal wall reconstruction with concurrent panniculectomy is associated with higher wound morbidity but similar surgical-site occurrence and hernia recurrence rates at long-term follow-up. The authors believe that panniculectomy can be safely performed when indicated.

Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction: A Propensity Score Analysis

Background Studies of abdominal wall reconstruction with concurrent panniculectomy have reported contradictory results. The authors hypothesized that patients undergoing abdominal wall reconstruction with concurrent panniculectomy experience more wound healing complications but similar rates of hernia recurrence compared with abdominal wall reconstruction alone. Methods Of 548 consecutive patients, 305 patients (55.7 percent) underwent abdominal wall reconstruction alone and 243 (44.3 percent) underwent abdominal wall reconstruction with concurrent panniculectomy. Mean follow-up was 30 months. The authors compared these two groups' postoperative complications and outcomes before and after propensity score analysis. Results Abdominal wall reconstruction with concurrent panniculectomy patients had a significantly higher overall complication rate (38.3 percent versus 29.2 percent; p = 0.025) and a trend toward a higher surgical-site occurrence rate (27.6 percent versus 20.7 percent; p = 0.06) compared with abdominal wall reconstruction alone. There were significantly higher incidences of skin dehiscence (19.3 percent versus 12.5 percent; p = 0.032), fat necrosis (10.7 percent versus 3.6 percent; p = 0.002), and infection abscess (9.5 percent versus 4.3 percent; p = 0.023) but no significant difference in hernia recurrence (6.9 percent versus 11.5 percent; p = 0.27) at long-term follow-up. Propensity score analysis yielded 188 pairs of matched patients with no significant differences in overall complication and hernia recurrence rates. Significantly higher rates of fat necrosis (9.6 percent versus 4.3 percent; p = 0.041) and abscess (10.1 percent versus 3.2 percent; p = 0.007) were observed in the abdominal wall reconstruction with concurrent panniculectomy group. Conclusions Abdominal wall reconstruction with concurrent panniculectomy is associated with higher wound morbidity but similar surgical-site occurrence and hernia recurrence rates at long-term follow-up. The authors believe that panniculectomy can be safely performed when indicated.

Relative Morbidity and Mortality of Panniculectomy-Combined Surgical Staging in Endometrial Cancer.

To examine intraoperative and postoperative complication rates for surgical staging combined with panniculectomy for endometrial cancer. A prospectively collected institutional surgical database was used to identify patients with endometrial cancer who underwent hysterectomy-based surgical staging between December 2008 and August 2014 (n = 551). The cases were grouped into surgical staging with panniculectomy (panniculectomy group, n = 11 [2.0%]), laparotomy without panniculectomy (laparotomy group, n = 208 [37.7%]), and laparoscopy (minimally invasive surgery group, n = 332 [60.3%]). Major complication and surgical wound complication rates within 30 days from surgery were compared. The panniculectomy group had a significantly higher body mass index compared with other approaches (panniculectomy group, laparotomy group, and minimally invasive surgery group: 60.4, 35.7, and 34.1; P < 0.001) and had a high stage I disease rate (90.9%, 61.5%, and 88.3%; P < 0.001). Mean pannus weight was 5733 g (4.4% of body weight). Intraoperative major complication rates were statistically nonsignificant across the groups (0%, 7.2%, and 4.2%; P = 0.23); however, the panniculectomy group had a significantly higher postoperative major complication rate compared with other approaches (36.4%, 16.3%, and 5.1%; P < 0.001). In multivariate analysis controlling for age, ethnicity, body habitus, medical comorbidities, and tumor factors, panniculectomy remained an independent predictor for increased risk of postoperative major complications (adjusted odds ratio, 4.37; P = 0.043). Surgical mortality rates were similar across the groups (0%, 0.5%, and 0%; P = 0.44). Among superobese patients (n = 50), intraoperative and postoperative complication rates were statistically similar across the 3 groups (all, P > 0.05). Although panniculectomy-combined surgical staging is associated with an increased risk of postoperative complications, the majority recovered uneventfully, making this approach a feasible treatment option, especially for superobese patients with endometrial cancer.

Surgical Site Occurrences of Simultaneous Panniculectomy and Incisional Hernia Repair

Horizontal panniculectomy (PAN) offers the advantage of wide exposure for hernia repair with elimination of excess skin and adiposity, at the expense of massive subcutaneous flap creation and its attendant risks. We report our experience with ventral hernia repair (VHR) with PAN compared with patients with hernia repair alone. A prospective database was reviewed retrospectively for all patients undergoing open VHR + PAN. A matched cohort of patients without PAN was used for comparison, resulting in 43 study and 43 control patients. Incidence of surgical site occurrences (SSO), surgical site infection (SSI), and recurrence were analyzed. A total of 43 patients underwent PAN + VHR with mesh. Mean body mass index was 34.3 kg/m(2), with 35 per cent having undergone prior bariatric surgery. Repair techniques included retromuscular (74.4%), preperitoneal (11.6%), intraperitoneal (6.9%), onlay (4.6%), and suture (2.3%). Mesh used was polypropylene (76.7%), polyester (18.6%), bioabsorbable (2.3%), and polytetrafluoroethylene (ePTFE) (2.3%). Component separation was performed in 44.2 per cent of patients. There was a significant difference in total SSO between PAN + VHR and VHR alone (46.5% vs 27.9%; P < 0.001), though the difference for individual SSOs was not significant. There was no difference in SSI between groups (16.3% vs 20.9%; P = 0.776). Mean follow-up was 11.4 months, with recurrence rate of 11.6 per cent in the PAN group and 9.3 per cent in the control group (P = 0.725). Panniculectomy at the time of VHR does not increase the incidence of SSI, though higher rates of skin necrosis and cellulitis were seen. There is no difference in recurrence. This approach is a valid option for patients with excessive abdominal panniculus requiring VHR.

Comparative study of wound complications: Isolated panniculectomy versus panniculectomy combined with ventral hernia repair

BackgroundThe resection of an abdominal pannus carries the risk of wound-related morbidity in obese patients. Surgeons often perform a panniculectomy (PAN) to gain better access to the abdomen to perform other operations. We evaluated the incidence of wound complications after PAN with and without a concomitant procedure (i.e., ventral hernia repair [VHR]). MethodsWe reviewed the prospective data from all patients who underwent PAN alone and PAN combined with VHR from 2007 to 2011 at a single institution. The demographic data, operative information, and postoperative wound complications and interventions were recorded and analyzed using standard statistical methods. Multivariate logistic regression analysis was performed to control for confounding factors. ResultsAfter excluding the patients who had undergone concomitant procedures involving the gastrointestinal or genitourinary tract, 185 patients were included in the present study (143 patients in the PAN-VHR group and 42 in the PAN group). The average patient age was 55.4 and 47.6 years in the two groups (P = 0.001). The average body mass index was 38.0 and 41.1 kg/m2 (P = 0.69). Of the 143 patients in the PAN-VHR group, 81.1% were women. In the PAN group, 92.9% were women (P = 0.09). The mean length of follow-up was 6.5 and 3.3 mo in the PAN-VHR and PAN groups, respectively (P = 0.04). In the PAN-VHR group, 96.5% underwent hernia repair with mesh and 29% underwent component separation. Subcutaneous talc was used in 58.6% of the PAN-VHR patients and 38.1% of the PAN patients (P = 0.02). Wound pulse-a-vac irrigation with bacitracin solution was used in 37.1% of PAN-VHR patients and 19.1% of the PAN patients (P = 0.03). The rate of wound complications and interventions for the PAN-VHR and PAN groups were not significantly different statistically (P < 0.05) and included seroma, seroma drainage, wound breakdown or necrosis, cellulitis, wound interventions, including bedside debridement and vac placement, and reoperation. After controlling for age, gender, body mass index, talc use, and pulse-a-vac irrigation use in the multivariate logistic regression analysis, the PAN-VHR group were more likely to develop cellulitis than the PAN-alone group (P = 0.004). The rates of all other wound complications were not significantly different statistically between the two groups after adjusting for confounding factors. ConclusionsPAN is associated with a significant risk of wound-related complications. The risk of postoperative cellulitis is increased further in patients who undergo concomitant VHR. However, the risk of all other wound complications and the need for interventions was not increased by performing concomitant VHR.

Perioperative morbidity associated with medically necessary panniculectomy in gynecologic oncology surgery

ObjectiveTo assess the data and outcomes of combining medically necessary panniculectomy with gynecologic oncology surgery and to discuss the associated perioperative and postoperative complications. MethodsIn a retrospective study of women with a body mass index (BMI) of greater than or equal to 35 who underwent gynecologic oncology surgery at Thomas Jefferson University Hospital, Philadelphia, between January 2005 and August 2011, patients were divided into 2 cohorts: those who had surgery with concurrent panniculectomy, and those who had surgery via standard laparotomy. Postoperative complications and lymph node (LN) yield were compared between the groups. ResultsPatient characteristics were comparable in both cohorts, except that the panniculectomy group had a greater BMI. Surgery combined with panniculectomy led to longer operating room times. Wound complications did not differ between the 2 groups. Panniculectomy did not affect LN yield or the development of venous thromboembolism. ConclusionThe data were reasonably consistent with previous studies. Although wound complications occurred, most were managed conservatively; as a result, overall morbidity was acceptable. Panniculectomy has been previously shown to facilitate lymphadenectomy and increase LN yield; however, the present results did not substantiate this conclusion. More research is required to determine which patients are optimal candidates for combined procedures.

Optimum repair for massive ventral hernias in the morbidly obese patient—is panniculectomy helpful?

Background The appropriate surgical management of morbidly obese patients with symptomatic hernias is not well defined. The authors evaluated the role of simultaneous panniculectomy in complex abdominal wall reconstruction. Methods A retrospective study (2007–2010) was conducted of morbidly obese (body mass index > 40 kg/m 2) patients undergoing open complex abdominal wall reconstruction. Results Thirty patients were identified. Twenty underwent simultaneous panniculectomy. The median pannus weight was 5.2 kg. Greater all-cause postoperative complications and wound-related morbidity occurred in the panniculectomy group ( P < .05). Performing a panniculectomy increased the risk for a wound complication by 5-fold ( P = .04). Following 7-month to 9-month follow-up, both groups had a recurrence rate of 10%. Conclusion Simultaneous panniculectomy in the setting of complex abdominal wall reconstruction is feasible but associated with significant postoperative morbidity. Its potential for benefit in reducing long-term hernia recurrence remains unclear.

Panniculectomy and Supraumbilical Vertical Midline Incisions in Morbidly Obese Gynecologic Oncology Patients

Background: We reviewed the outcomes of panniculectomy and supraumbilical vertical midline incisions in morbidly obese women undergoing gynecologic operations. Study Design: Medical records were reviewed for 62 morbidly obese women with a large dependent pannus who underwent gynecologic operations on the Gynecologic Oncology Service at the State University of New York at Stony Brook between May 1990 and July 1997. Thirty-five patients underwent panniculectomy and 27 had a supraumbilical vertical midline incision, forming the study groups. The patient charts were abstracted for demographic, perioperative, and postoperative data. Results: For the entire study population, the average age was 56 years, the mean body mass was 128.6 kg, and the mean Quetelet Index was 48.3 kg/m 2. The mean operative time and estimated blood loss were similar for both groups. Eight percent of the patients had urologic injuries, evenly distributed between the groups. Postoperative infections, wound breakdowns, and hospital stay were greater for the panniculectomy group than for the supraumbilical vertical midline incision group (p < 0.05). Uniform use of subcutaneous closed-suction drains (since 1995) was associated with a significant reduction in the incidence of wound breakdowns and a shorter hospital stay in the panniculectomy group. Conclusions: Panniculectomy and supraumbilical vertical midline incision provide reasonable peritoneal access with acceptable rates of postoperative complications for morbidly obese women undergoing gynecologic operations.