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Panniculectomy after Bariatric Surgery: A Morbid Procedure after Morbid Obesity

Michael J Derickson, MD, Cody J Phillips, DO, Morgan R Barron, MD, John P Kuckelman, DO, Mia D DeBarros, MD, Matthew J Martin, MD. Madigan Army Medical Center

INTRODUCTION: Bariatric surgery often results in rapid massive weight loss, leaving many with redundant skin that can cause significant physical and psychosocial limitations. Body contouring procedures in this setting are known to have high complication rates. We sought to identify variables associated with postoperative complications and adjuncts associated with prevention or mitigation of postoperative complications.

METHODS AND PROCEDURES: A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period. Perioperative data was obtained via chart review. Cohort characteristics and perioperative data were evaluated including pre-bariatric and pre-panniculectomy BMI, operative data and post-operative course. Data were analyzed using descriptive and inferential analysis. Complication severity was stratified using the modified Clavien-Dindo classification.

RESULTS: There were 706 patients identified; the majority were female (95%) and the mean age was 42. The average post-bariatric weight loss and pre-panniculectomy weight were 48 kg and 77 kg, respectively. The overall complication rate was 56%, with skin dehiscence the most common (24%), followed by surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Rate of return to operating room was 12%. Complications stratified by Clavien-Dindo were as follows: Grade I 25%, Grade II 17%, Grade IIIa 2%, and Grade IIIb 11%. Two patients had Grade IVa complications, and one patient died in the series (Grade V). Significant independent predictors of complication were advanced age, intraoperative blood loss, and diabetes mellitus. There was no significant difference in complications based on type of bariatric procedure, however, BMI >26 was associated with a higher complication rate (69%) versus BMI <26 (50%) (p=.0045). The type of incision also had a significant impact, with complications in 64% of “fleur-de-lis” versus 49% of low transverse incisions (p<0.01). Patients undergoing concomitant hernia repair had higher complications at 64% versus 49% without hernia repair (p<0.01).

CONCLUSION: Post-bariatric panniculectomy is a common procedure due to cosmetic and functional limitations. Maximal weight loss should be obtained to reduce the risk of complication. Low transverse panniculectomy alone is preferred. Patients with non-modifiable risk factors should be counseled on their increased complication risk. A quality improvement initiative has resulted at this institution due to the results of the study.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 81037

Program Number: MSS08

Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations

Presentation Type: MSSPodium

401

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