Panniculectomy and the separation-of-parts hernia repair: a solution for the large infraumbilical hernia in the obese patient.

Abstract

Infraumbilical hernias in the obese are problematic in terms of achieving adequate exposure and eventual wound healing. Simultaneous panniculectomy with separation-of-parts hernia repair is one approach to this reconstructive issue, but the feasibility of such a combination is untested. Twenty-four simultaneous panniculectomy and separation-of-parts hernia repairs performed by the senior surgeon over a 6-year period are presented. Patients were analyzed by preoperative, intraoperative, and postoperative parameters. Complications were grouped into major and minor categories. Average patient body mass index was 39 (range, 29 to 57). Twenty of 24 (83 percent) of the hernias were recurrent on initial presentation. Almost one-half of the cases were contaminated (46 percent), marked by the presence of a preoperative wound (29 percent) or concurrent gastrointestinal procedure (17 percent). In 25 percent of cases, a preexisting laparotomy scar necessitated a vertical reopening of the abdominal skin, raising the stakes for postoperative wound breakdown. Despite these findings, major/minor wound complications (12.5 percent/33 percent) and additional surgery rates (17 percent) were relatively low considering this morbidly obese population. Postoperative wound complications, hernia recurrence, and reoperation rates were significantly increased among those patients whose body mass index exceeded 35(p < 0.05). All hernia recurrences (n = 4) were corrected definitively with a secondary direct repair. Mean follow-up was 10 months (range, 3 to 60 months). The separation-of-parts hernia repair in combination with pannus resection can be performed safely in obese patients, with complication rates comparable to those reported in the literature. This combined procedure has become the authors' procedure of choice in these difficult clinical situations.