Abdominal Panniculectomy: An Analysis of Outcomes in 238 Consecutive Patients over 10 Years

The Impact of Body Mass Index on Adverse Outcomes Associated with Panniculectomy: A Multimodal Analysis

BACKGROUND

Overhanging pannus may be detrimental to ambulation, urination, sexual function, and social well-being. Massive weight loss patients often have high residual body mass index (BMI) and comorbidities presenting a unique challenge in panniculectomy patient selection. This study aims to better characterize the role of BMI in postoperative complications following panniculectomy.

METHODS

A meta-analysis attempted to assess the impact of BMI on complications following panniculectomy. Cochrane Q and I2 test statistics measured study heterogeneity, with subsequent random effects meta-regression investigating these results. After this, all panniculectomy patients in the National Surgical Quality Improvement Program database in the years 2007 to 2019 were analyzed. Univariate and multivariable tests assessed the relative role of BMI on 30-day postoperative complications.

RESULTS

Thirty-four studies satisfied inclusion criteria, revealing very high heterogeneity (Cochrane Q = 2453.3; I2 = 99.1%), precluding further meta-analysis results. Receiver operating characteristic curves demonstrated BMI was a significant predictor of both all causes (area under the curve, 0.64; 95% CI, 0.62 to 0.66) and wound complications (area under the curve, 0.66; 95% CI, 0.63 to 0.69). BMI remained significant following multivariable regression analyses. Restricted cubic spines demonstrated marginal increases in complication incidence above 33.2 and 35 kg/m 2 for all-cause and wound complications, respectively.

CONCLUSIONS

Reported literature regarding postoperative complications in panniculectomy patients is highly heterogeneous and may limit evidence-based care. Complication incidence positively correlated with BMI, although the receiver operating characteristic curve demonstrated its limitations as the sole predictive variable. Furthermore, restricted cubic splines demonstrated diminishing marginal predictive capacity of BMI for incremental increases in BMIs above 33.2 to 35 kg/m 2 . These findings support a reevaluation of the role of BMI cutoffs in panniculectomy patient selection.

Technical Considerations and Outcomes for Panniculectomy in the Setting of Buried Penis Patients: A Systematic Review and Database Analysis

BACKGROUND

Often secondary to obesity, adult-acquired buried penis (AABP) is an increasingly common condition. AABP is often detrimental to urinary and sexual function, psychological well-being, and quality of life. Surgical treatment involves resection of excess soft tissue, with adjunct procedures, including a panniculectomy. However, few studies have been conducted investigating the risks of panniculectomy in the context of AABP surgical repair.

METHODS

A systematic review of PubMed, Embase, and Cochrane databases was performed, following the PRISMA 2020 guidelines. Descriptive statistics regarding patient demographics, complications, and surgical technique were conducted. After this, an analysis of AABP patients within the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was conducted.

RESULTS

Four studies including 57 patients reported panniculectomy as part of buried penis repair (PBPR). Surgical approaches included a modified trapezoid and traditional transverse incision. All authors utilized postoperative drains. Dehiscence and wound infection were the most frequent complications. Univariate NSQIP analysis revealed that PBPR patients had higher body mass index, more comorbidities, and greater wound complication rates. Multivariate analysis revealed that PBPR did not significantly increase 30-day complications compared to isolated BPR ( P > 0.05), while body mass index remained a significant predictor.

CONCLUSIONS

Surgical repair of AABP can greatly improve patient quality of life. The available literature and NSQIP-based analysis reveal that concurrent panniculectomy in AABP repair has a comparable complication profile. Future studies are necessary to better characterize the long-term outcomes of this PBPR.

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery

Background

Abdominal panniculectomy after weight loss is a commonly performed procedure with high patient satisfaction yet continues to have a high post-operative complication profile. Several risk-reducing surgical approaches, such as preservation of Scarpa’s fascia, use of tissue adhesives, and progressive tension suture techniques have been described. However, the use of tranexamic acid (TXA) has not been previously reported in panniculectomy surgery.

Objectives

To improve the safety and predictability of this procedure, the authors investigate whether the use of topically administered TXA during panniculectomy surgery reduces seroma, hematoma, and drain duration.

Methods

Consecutive patients who underwent panniculectomy (January 2010 to January 2022) were retrospectively reviewed. Outcome measures included hematoma requiring surgical evacuation, seroma requiring percutaneous aspiration, and drain duration. Patients with thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared with a historical control group who had not received TXA.

Results

A total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months (3.7 years). The median (range) resection weight was 2.6 kg (0.15-19.96 kg). Regarding seroma and hematoma formation, the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio [OR] = 1.7, 95% CI [0.56- 4.8], P = 0.38 and OR = 2.1, 95% CI [0.4-11.8], P = 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group (18.1 [12.1] days vs 19.8 [13.9] days); however, this difference was not statistically significant, albeit clinically significant.

Conclusions

As the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although previous studies report hematoma and seroma risk reduction, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in body contouring are needed.

Level of Evidence: 3