Hysterectomy with Concurrent Panniculectomy

Forte, Antonio J.; Tuggle, Charles T.; Berlin, Nicholas L.; Fischer, John P.; Persing, John A.

doi:10.1097/prs.0000000000001535

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…Existing studies fail to provide proof of these claims for several reasons, the main reason being study design. Many studies report on abdominoplasty and not panniculectomy specifically, or report mixed patient populations combining both obese and nonobese patients 3,4,17–24 . Many studies are simply case series without comparative cohorts nor do they use historical data 1,2,16,18,25–27 .…”

Section: Discussionmentioning

confidence: 99%

“…Many studies report on abdominoplasty and not panniculectomy specifically, or report mixed patient populations combining both obese and nonobese patients. 3,4,[17][18][19][20][21][22][23][24] Many studies are simply case series without comparative cohorts nor do they use historical data. 1,2,16,18,[25][26][27] Most importantly, lacking in these studies are designs that directly compare groups of patients operated on by the same surgeons with the same criteria in significant number.…”

Section: Discussionmentioning

confidence: 99%

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Panniculectomy Performed in Conjunction With Gynecologic Surgery in Obese and Morbidly Obese Patients

Nag¹,

Patel²,

Gaughan

et al. 2021

Ann Plast Surg

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Introduction Panniculectomy is a common procedure in plastic surgery, often performed after massive weight loss and in morbidly obese patients. It is also performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates and benefit the patient (Am J Obstet Gynecol, 2000. 182, 1502–1505; J Gynecol Technol, 1997;3:9–16; J Am Coll Surg, 1995). These and other studies fail to provide proof of these claims for a number of reasons, including study design, lack of a control group and the inclusion of nonmorbidly obese patients (J Am Coll Surg, 1995; Gynecol Oncol, 1998, 70, 80–86; Int J Gynecol Cancer, 2015;25(8):1503–1512). Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving toward penalizing practices, which increase complications. The aim of this study was to evaluate the premise that the addition of panniculectomy to gynecologic surgery in the obese and morbidly obese patient population results in a statistically significant improvement in measureable outcomes. Methods/Results The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to assess the association of complications with panniculectomy combined with gynecologic surgery in the morbidly obese patient population. The query identified 296 patients with a body mass index greater than 30 who had panniculectomy concomitant with gynecologic surgery. The results demonstrated a statistically significant relationship (P < 0.05) of these concomitant procedures with superficial infection, wound infection, pulmonary embolism, systemic sepsis, return to operating room, length of operation and length of stay. A systematic review of the literature was then performed which identified only 5 studies that included comparative cohorts of those with gynecologic surgery, with and without panniculectomy. There was no significant benefit across the studies in measured paramters. Conclusions This NSQIP study and systematic review of the existing literature does not support the premise that there is a statistically significant benefit associated with performing panniculectomy in conjunction with gynecologic surgery in the morbidly obese patient population. The NSQIP data demonstrate significant elevation of negative outcomes in morbidly obese patients undergoing combined procedures. In the light of the risks to patients and current direction of medical practice the addition of elective panniculectomy to gynecologic surgery should be reevaluated in the a patient population with a body mass index greater than 30.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Panniculectomy Performed in Conjunction With Gynecologic Surgery in Obese and Morbidly Obese Patients

Nag¹,

Patel²,

Gaughan

et al. 2021

Ann Plast Surg

View full text Add to dashboard Cite

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“…The role of the plastic surgeon is integral in this process, as complications rates more than double when panniculectomies are performed by nonplastic surgeons 9 . When performed by a plastic surgeon, panniculectomy can be safely combined with other surgical procedures including ventral hernia repair, gynecologic procedures, and abdominal wall reconstruction 10–15 …”

Section: Discussionmentioning

confidence: 99%

“…9 When performed by a plastic surgeon, panniculectomy can be safely combined with other surgical procedures including ventral hernia repair, gynecologic procedures, and abdominal wall reconstruction. [10][11][12][13][14][15] Although panniculectomy is a beneficial procedure, it carries a moderate risk of complications. We found an overall complication rate of 40% in our series, which is consistent with prior reports ranging from 40% to 56% [16][17][18][19][20] ; however, half of these complications were managed in the clinic setting.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Outcomes and Weight Loss After Panniculectomy

et al. 2021

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Objective The objective of this study was to evaluate long-term outcomes and weight loss after panniculectomy. Methods A retrospective chart review study was performed on 225 consecutive patients who had undergone panniculectomy from 2002 and 2020. Demographic variables including smoking status, medical comorbidities, and prior history of weight loss/bariatric surgery were collected for 173 patients. Preoperative and postoperative body mass index (BMI) were calculated in addition to postoperative outcomes. Results The study population was 85% female with a mean age of 57 years and an average follow-up of 3.9 years. Relevant comorbidities included obesity (88%), hypertension (65%), diabetes (37%), and smoking (8%), and the majority (53%) of patients had undergone prior bariatric surgery. The overall complication rate was 40%. Twenty percent of patients required reoperation or readmission, and 20% had minor complications addressed in an outpatient setting. Patients who had higher preoperative BMI experienced a significant long-term reduction in BMI. In addition, patients who did not undergo prior bariatric surgery tended to lose weight more often and by larger amounts than patients who had prior bariatric surgery (71.6% vs 57.6, P = 0.023). Complications were not uncommon and included infection (17%), delayed wound healing (16%), seroma (8%), and hematoma (3%). Patients who had prior bariatric surgery were at reduced risk of any complication (P = 0.012). Smoking increased the incidence of infection (38.5% of smokers vs 15.6% of nonsmokers, P = 0.039). Concomitant hernia repair increased the risk of overall complications (64.3% vs 35.9%, P = 0.003) and delayed wound healing (39.2% vs 11.7%, P < 0.001). In the subgroup of patients who did not lose weight, a panniculus weight greater than 5 kg was associated with an increased complication rate (61.5% vs 27%, P = 0.03). Conclusions Patients who underwent a panniculectomy tended to lose weight postoperatively, particularly those who had not undergone previous bariatric surgery. Complications were not uncommon, especially in patients with a smoking history. Prior bariatric surgery patients had a significant decrease in postoperative complications but tended to lose less weight after panniculectomy than those without prior bariatric surgery. Concomitant hernia repair put patients at an increased risk of complications.

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