Optimum repair for massive ventral hernias in the morbidly obese patient--is panniculectomy helpful?

Harth, Karem C; Blatnik, Jeffrey A; Rosen, Michael J

BACKGROUND The appropriate surgical management of morbidly obese patients with symptomatic hernias is not well defined. The authors evaluated the role of simultaneous panniculectomy in complex abdominal wall reconstruction. METHODS A retrospective study (2007-2010) was conducted of morbidly obese (body mass index > 40 kg/m(2)) patients undergoing open complex abdominal wall reconstruction. RESULTS Thirty patients were identified. Twenty underwent simultaneous panniculectomy. The median pannus weight was 5.2 kg. Greater all-cause postoperative complications and wound-related morbidity occurred in the panniculectomy group (P < .05). Performing a panniculectomy increased the risk for a wound complication by 5-fold (P = .04). Following 7-month to 9-month follow-up, both groups had a recurrence rate of 10%. CONCLUSION Simultaneous panniculectomy in the setting of complex abdominal wall reconstruction is feasible but associated with significant postoperative morbidity. Its potential for benefit in reducing long-term hernia recurrence remains unclear.