Abdominal Panniculectomy after Massive
Weight Loss
A Clinical Study
Purpose
Obesity is a disease steadily increasing in incidence and prevalence,
affecting all age groups and ethnicities. The medical complications of
obesity are well known. Dramatic weight reduction achieved through diet
and exercise or surgery can reverse morbidity and mortality associated
with obesity. Sequelae of massive weight loss include skin redundancy
and fascial laxity, particularly in the abdomen. The abdominal pannus
causes disabling rashes, pain, physical limitation, back strain, and cosmetic
deformity, and symptoms are more marked the heavier the pannus. Panniculectomy
can treat these symptoms, but the approach must be customized due to complex
medical and surgical histories related to obesity and the size of the
pannus. The aim of this study was to analyze a series of massive panniculectomies
greater than 10 pounds following massive weight loss to better characterize
the patients receiving these procedures and the outcomes achieved.
Method
All patients undergoing massive abdominal panniculectomy by a single surgeon
at an academic hospital from October 2000 to December 2003 were retrospectively
studied. Seven men and 17 women qualified: 1 woman had a 2 stage abdominal
panniculectomy, each time with greater than 10 lb abdominal skin resections.
All but 1 patient had gastric bypass. Average weight loss was 171 lb,
with average maximum BMI of 70.5, and minimum BMI of 43.7. (Morbid obesity
= BMI > 35) Patient presentation was regularly complicated by upper
midline incisional hernias with adherent scar, and abdominal scars from
unrelated previous surgery including subcostal incisions. Abdominal panniculectomy
was performed with conservative undermining, often assisted by suspending
the skin from ceiling chains. Hernias were repaired at the time of surgery
by approximation and plication of the fascia. Lax fascia was plicated
as well. Closure of the skin was performed in a layered fashion over 2
to 4 Jackson-Pratt drains. Ambulation was encouraged within 24 hours of
surgery.
Results
Average abdominal skin resection was 16.1 lb, ranging from 10.3 to 49
lb. Hernia repair was necessary in 13 patients, and mesh was not used
in any patient. Additional surgery performed at the time of panniculectomy
included skin reduction surgery of the back (40%), chest (32%), inner
thigh (28%), and arm (28%). Blood transfusion was necessary in 5 (20%)
of the cases. Length of stay averaged 3 days. Complications included wounds
requiring debridement, dressings, VAC therapy and/or delayed primary closure
(20%); and seroma requiring drain replacement or dressings (28%). Uncomplicated
healing occurred in 44% of cases. There were no DVT’s or mortalities.
Conclusions
Massive abdominal panniculectomy is challenging to plan, execute and manage
after surgery. We present our approach to these patients with acceptable
results.
Source:
Michele A Shermak, MD, FACS and Michele A. Manahan, MD.
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