Panniculectomy as an integral part of pelvic operation is an underutilized technique in patients with morbid obesity.

Abstract

Panniculectomy integrated into pelvic procedures mandated in morbidly obese patients is a well described technique. Nevertheless, the abdominal cavity in such patients is generally approached through a vertical incision, frequently by forcibly pulling the panniculus inferiorly. Such a vertical approach has been associated with significant wound morbidity. Patients were offered removal of excess abdominal skin without cosmetic intent. The mean weight of patients was 126 kg and the body mass index ranged from 29.4 to 59.9. The object of this study was to discover whether or not operative access was facilitated and whether or not wound morbidity was reduced. Fifteen patients had significant medical problems and nine of the 16 had an umbilical hernia. Removal of the panniculus seemed to facilitate access to the abdomen, provided excellent exposure, and certainly allowed ready repair of the umbilical hernia with a Blake technique. All but one of the wounds healed by first intention, and in that patient, an 8 cm segment was easily resutured. The operative time was acceptable. There was no increased blood loss associated with the panniculectomy, but of note is the fact that the hematocrit level decreased in five patients on days 2 to 5 postoperatively without hematoma formation. Conservative panniculectomy to facilitate access to the pelvic area seems to be an advantageous procedure, with good wound healing, and deserves a randomized prospective study comparing it to a vertical incisional approach to validate its technical superiority.