Assessing the Safety and Efficacy of Combined Abdominoplasty and Gynecologic Surgery

Sinno, Sammy; Shah, Samir; Kenton, Kimberly; Brubaker, Linda; Angelats, Juan; Vandevender, Darl; Cimino, Victor

doi:10.1097/sap.0b013e3181f9b245

Cited by 19 publications

(13 citation statements)

References 12 publications

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“…One study discouraged ABP combined with cesarean delivery due to increased complications and unsatisfactory aesthetic outcomes [17]. More recently, most groups believe that a combined ABP-HYS is safe and does not have any increase in complication rates when compared to ABP and HYS on separate dates [1,[6][7][8][9][10]. One study even showed that concurrent ABP and panniculectomy with pelvic surgery in the morbidly obese had a lower incidence of wound infection and blood loss than pelvic surgery alone [18].…”

Section: Discussionmentioning

confidence: 95%

“…Certain groups have reported that the combined procedure resulted in increased complications, particularly in an increased incidence of pulmonary embolus [2][3][4][5]. More recently, others have indicated that ABP-HYS is safe and does not result in an increase in complication rates when compared to ABP and HYS on separate dates [1,[6][7][8][9][10]. Additionally, it has been shown that the combined procedure can allow greater operative exposure, thus aiding the gynecologic surgeon [11].…”

Section: Introductionmentioning

confidence: 93%

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Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study

et al. 2015

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 93%

Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study

et al. 2015

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“…The rate varies from 0.1% to 42%. [12] Seromas are distinctly more common in traditional abdominoplasty and distinctly less common in lipoabdominoplasty. [13] The earlier reports suggested that addition of liposuction increased the seroma rates, however in these series, the abdominoplasty was still done with full undermining to the rib cage.…”

Section: Discussionmentioning

confidence: 99%

Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps

Rangaswamy

2013

Indian J Plast Surg

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Significant complications still occur after abdominoplasty, the rate varies widely in different series. This variation suggests that there is a lot of scope for improvement. This paper reviews the various complications and also the technical improvements reported in the last 20 years. The root cause of each complication is analysed and preventive steps are suggested based on the literature and the author's own personal series with very low complication rates. Proper case selection, risk stratified prophylaxis of thromboembolism, initial synchronous liposuction, flap elevation at the Scarpa fascia level, discontinuous incremental flap dissection, vascular preservation and obliteration of the sub-flap space by multiple sutures emerge as the strongest preventive factors. It is proposed that most of the complications of abdominoplasty are preventable and that it is possible to greatly enhance the aesthetic and safety profile of this surgery.

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“…There were no deep space infections or wound dehiscences (8). More recently, a case-control study compared patients undergoing combined abdominoplasty and gynecological surgery with individuals undergoing abdominoplasty alone and gynecological surgery alone (9). The combined group experienced no increased complications and, actually, when compared with the sum of procedures when performed alone, there were significant reductions in operative times, estimated blood loss and total length of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Concomitant sublay mesh repair of umbilical hernia and abdominoplasty

McKnight

Fowler

Cobb

et al. 2012

Canadian Journal of Plastic Surgery

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U mbilical hernias are occasionally present in patients desiring abdominoplasty. Current data strongly support the use of synthetic mesh when repairing ventral hernias >3 cm in diameter. Longterm data demonstrate improved recurrence rates with mesh, even for smaller umbilical defects (1,2). With simultaneous abdominoplasty, an open approach to umbilical herniorrhaphy is preferred due to the improved exposure; however, dissection of an umbilical hernia at the fascial level can damage the umbilical perforating vessels, resulting in necrosis and loss. During abdominoplasty, circumferential skin incision around the umbilicus divides the subdermal vessels, making it dependent on the deep inferior epigastric supply. This blood supply originates from the deep inferior epigastric artery, traverses the rectus abdominus muscle and continues through the anterior rectus fascia. Traditional hernia repair, as an onlay or subfascial mesh placement, risks deep umbilical blood flow. Unilateral approach with dissection in the preperitoneal plane enables preservation of unilateral and, potentially, bilateral deep perfusion because the dissection plane is deep to the posterior rectus sheath.We present a patient with a defect 3 cm in size at the umbilicus hernia and diastasis presenting for simultaneous open mesh umbilical hernia repair and abdominoplasty (Figure 1). Umbilical perfusion was maintained during open repair with preservation of unilateral deep perforating vessels and placement of mesh in a plane consisting of both the preperitoneal and retrorectus space. Surgical TechniqueThe patient was marked preoperatively for lower abdominal incision. The skin was incised and dissection was taken through Scarpa's fascia to the deep fascia of the abdominal wall. The umbilicus was incised circumferentially through the skin. The cutaneous flap was raised to the umbilical incision and the flap was split and subcutaneous dissection bevelled away from the umbilicus to the fascia and preserved periumbilical perfusion. The adipocutaneous flap was elevated to the xiphoid and medial costal margins. The anterior rectus sheath was incised over the right rectus muscle. Dissection was carried through the medial posterior rectus sheath to the preperitoneal plane adjacent to the hernia. Contents of the hernia were reduced. The contralateral rectus preperitoneal plane was dissected for placement of mesh with peripheral fascial overlap. The umbilical stalk and perforating vessels were preserved on the contralateral side. The peritoneum was reapproximated in the midline to 'close off' the abdominal cavity. This manoeuvre created a pocket deep to the fascia to lay mesh (Figure 2). A lightweight polypropylene mesh was used in this retrorectus position in the preperitoneal space to reinforce the midline closure (Figure 3). The mesh was secured with transabdominal wall monofilament permanent sutures. The linea alba was recreated with long-acting absorbable sutures. Midline plicating sutures were placed above and below the umbilicus. The cutaneous flap was...

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Assessing the Safety and Efficacy of Combined Abdominoplasty and Gynecologic Surgery

Abstract: These results demonstrate success in performing abdominoplasty with gynecologic surgery, which may be an acceptable option for patients.

Cited by 19 publications

References 12 publications

Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study

Outcomes and Safety of the Combined Abdominoplasty-Hysterectomy: A Preliminary Study

Minimising complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps

Concomitant sublay mesh repair of umbilical hernia and abdominoplasty

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