Panniculectomy in the Still Obese Patient: Indications, Technique, and Outcomes

Mitchell, Ryan

Goals/Purpose: Panniculectomy in the extremely obese patient is usually deferred until further weight loss due to high surgical risk. However, some patients are not bariatric surgical candidates due to a true giant pannus that prohibits ambulation or has developed recurrent infections, thereby necessitating a surgical panniculectomy prior to weight loss. A previously published top-down approach to panniculectomy resulted in a 42.3% complication rate, with 11.5% major complications. We describe our experience in this population using a suspension bottom-up technique.

Methods/Technique: A retrospective chart review of patients who underwent resection of a true giant pannus using a suspension technique between January 2003 and August 2013. Significant pannus was defined as requiring suspension and a weight greater than 10 kilograms. The pannus is elevated using the Hoyer lift, Steinman pins, and traction bows. Specific details will be described. Patient demographics, indications for surgery, procedures performed, and complications were recorded.

Results/Complications: Fourteen patients were identified with a mean follow up period of 12 months. Mean pannus weight was 24.24 Kg (10.5 – 61.2 Kg). Mean age at surgery was 54.3 years with a mean BMI of 58.7 kg/m². Overall complication rate, including non-operative intervention, was 50%. There were 5 wound breakdowns and 1 seroma, all managed by local wound measures. One major complication was encountered requiring a reoperative event for hematoma (7.1%). The most common concomitant procedure was hernia repair (85.7%). Fifty-eight percent of the hernias corrected could not be identified during physical exam. No patients required blood transfusions.

Conclusion: Surgical correction of a true giant pannus is a difficult undertaking and requires significant preoperative planning. Elevation of the pannus allows for improved pulmonary compliance, venous return, and less operator stress. Patients have a 50% chance of a complication with these procedures; however, 85% of all complications were considered minor and resolved with conservative management.