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Abdominal Panniculectomies: High Patient Satisfaction Despite Significant Complication Rates

Cooper, Joshua M. MD*; Paige, Keith T. MD, FACS; Beshlian, Kevin M. MD, FACS; Downey, Daniel L. MD, FACS; Thirlby, Richard C. MD, FACS*

doi: 10.1097/SAP.0b013e318158a7b2
Reconstructive Surgery and Burns

Background: We reviewed our experience with 3 operative techniques for abdominal panniculectomies to determine differences in complication rates and levels of patient satisfaction.

Methods: This retrospective study included 92 consecutive patients who underwent abdominal panniculectomies over a 9-year period. Patients underwent one of 3 panniculectomy techniques: fleur-de-lis (n = 25), transverse incisions with minimal undermining (n = 30), or transverse incisions with extensive undermining (n = 37). Postoperatively, patient satisfaction surveys were completed.

Results: Median pannus weight was 4.4 kg (range, 1.6–20.5). Sixty-eight patients (73.9%) had a previous gastric bypass. Median body mass index (BMI) was 38 kg/m2 (range, 22–66.9). Median follow-up for complications was 8.1 week (range, 1–235). Forty of 92 patients (43%) suffered wound complications. The reoperation rate was 13%. Postoperative complication rates were higher among hypertensive patients (61% vs. 36%; P = 0.04). There was a trend towards increased complications among those with higher BMI and pannus weights. There was not a significant relationship between operative technique and overall complication rate.

Mean length of follow-up for patient questionnaire completion was 2 years, 11 months (range, 1–9 years). Eighty-one percent of those responding to the mailed questionnaire were satisfied with their operative results. There were no statistically significant differences between the technique used and patient satisfaction level.

Concomitant hernia repair was performed in 47% of patients without increased wound complications.

Conclusions: Patients were satisfied with the results of their panniculectomy, although complications were common. Higher BMI, larger pannus size, and hypertension were correlated with increased complication rates. The minimal undermining, extensive undermining, and the fleur-de-lis panniculectomy techniques result in similar patient satisfaction rates and complication rates.

From the *Department of General, Thoracic, and Vascular Surgery, and †Section of Plastic and Reconstructive Surgery, Virginia Mason Medical Center, Seattle, WA.

Received May 14, 2007, and accepted for publication, after revision, August 16, 2007.

Joshua M. Cooper, MD is currently a plastic surgery fellow at Indiana University, Indianapolis, Indiana.

Daniel L. Downey, MD, FACS is currently affiliated with Northwest Hospital and Medical Center, Seattle, Washington.

Reprints: Richard C. Thirlby, MD, FACS, Department of Surgery, Virginia Mason Medical Center, 1100 Ninth Ave, C6-GSUR, Seattle, WA 98111. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.