Top

Hernia

Published in:

01-02-2022 | Obesity | Original Article

Is simultaneous panniculectomy an ideal approach to repair a ventral hernia: a general surgeon’s experience

Authors: K. Slater, A. A. Ajjikuttira

Published in: Hernia | Issue 1/2022

Abstract

Background

The number of Australian patients undergoing ventral hernia repair has seen a significant increase in the last twenty years. With the obesity epidemic, the general surgeon is frequently seeing patients with hernias and significant abdominal aprons and is being asked to address this at the time of the hernia repair. This can be performed utilising a general surgery and plastic surgery team, but there may be some advantages to general surgeon being able incorporate this into their practice. We present our approach to patients undergoing ventral hernia repair and simultaneous panniculectomy (VHR + PAN) by a single general surgeon.

Methods

Data were analysed from a single surgeon’s experience performing VHR + PAN at the same operation. Data were collected prospectively from 2009 to 2020. 146 cases of patients undergoing VHR + PAN were identified and included in this study.

Results

The mean age of patients undergoing VHR + PAN was 58 years. The mean BMI was 35, with 59% of patients losing weight loss prior to surgery. 66% of patients had a hernia repair with biosynthetic mesh and 91% of patients had retro-rectus or pre-peritoneal mesh approach to the repair. 42% of patients had a post-operative complication with 80.6% of these being related to surgical-site occurrences. Other complications included gastrointestinal (14%), respiratory (13%) and venous thromboembolism, such as a deep vein thrombus or pulmonary embolism (6%). There were 2 deaths in the series (1.3%). The hernia recurrence rate was 6%.

Conclusion

Simultaneous PAN is possible in patients with an abdominal apron who are undergoing VHR, with an acceptable risk of SSOs and other complications. This technique provides excellent exposure and with appropriate training is well within the remit of the general surgeon. This may save further operative management in the future and can offer patients improved self-esteem, mobility, and independence. Patient optimisation is key, paying careful attention to pre-operative weight loss, diabetic control, smoking cessation and respiratory function. VHR + PAN is an important technique that should be in the repertoire of all abdominal wall reconstruction units.

Medicare Australia (2017) Medicare statistics item number reports. http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp. Accesssed Oct 2017.

Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8(1):42–46 (Epub 2003 Sep 6)CrossRef

Australian Bureau of Statistics (2013) Overweight and obesity. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4338.0~2011-13~Main%20Features~Overweight%20and%20obesity~10007. Accessed Oct 2017.

Fischer JP, Tuggle CT, Wes AM, Kovach SJ (2014) Concurrent panniculectomy with open ventral hernia repair has added risk versus ventral hernia repair: an analysis of the ACS-NSQIP database. J Plast Reconstr Aesthet Surg 67(5):693–701. https://doi.org/10.1016/j.bjps.2014.01.021 (Epub 2014 Jan 28)CrossRefPubMed

Zemlyak AY, Colavita PD, El Djouzi S, Walters AL, Hammond L, Hammond B, Tsirline VB, Getz S, Heniford BT (2012) Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. J Surg Res 177(2):387–391. https://doi.org/10.1016/j.jss.2012.06.029 (Epub 2012 Jul 6)CrossRefPubMed

Okusanya OT, Scott MF, Low DW, Morris JB (2014) The partial underlay preperitoneal with panniculectomy repair for incisional abdominal hernia in the morbidly obese. Surg Obes Relat Dis. 10(3):495–501. https://doi.org/10.1016/j.soard.2013.07.013CrossRefPubMed

Espinosa-de-Los-Monteros A, Avendaño-Peza H, Gómez-Arcive Z, Martin-Del-Campo LA, Navarro-Navarro JA (2016) Total abdominal wall reconstruction with component separation, reinforcement, and vertical abdominoplasty in patients with complex ventral hernias. Aesthetic Plast Surg 40(3):387–394. https://doi.org/10.1007/s00266-016-0628-7 (Epub 2016 Mar 2)CrossRefPubMed

Pestana IA, Campbell D, Fearmonti RM, Bond JE, Erdmann D (2014) “Supersize” panniculectomy: indications, technique, and results. Ann Plast Surg 73(4):416–421. https://doi.org/10.1097/SAP.0b013e31827f5496CrossRefPubMed

Petty P, Manson PN, Black R, Romano JJ, Sitzman J, Vogel J (1992) Panniculus morbidus. Ann Plast Surg 28(5):442–452CrossRef

10.

Brown M, Adenuga P, Soltanian H (2014) Massive panniculectomy in the super obese and super-super obese: retrospective comparison of primary closure versus partial open wound management. Plast Reconstr Surg 133(1):32–39. https://doi.org/10.1097/01.prs.0000436818.34332.34CrossRefPubMed

11.

Moreno-Egea A, Campillo-Soto A, Morales-Cuenca G (2016) Does abdominoplasty add morbidity to incisional hernia repair? A Randomized Controlled Trial. Surg Innov 23(5):474–480. https://doi.org/10.1177/1553350616646480CrossRefPubMed

12.

Warren JA, Epps M, Debrux C, Fowler JL, Ewing JA, Cobb WS 4th, Carbonell AM (2014) Panniculectomy and Incisional Hernia Repair. Am Surgeon 81(8):764–769CrossRef

13.

Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Rosenblatt S, Poulose BK, Rosen MJ (2018) A call for standardization of wound events reporting following ventral hernia repair. Hernia 22(5):729–736. https://doi.org/10.1007/s10029-018-1748-6CrossRefPubMed

14.

Igwe D Jr, Stanczyk M, Lee H, Felahy B, Tambi J, Fobi MA (2000) Panniculectomy adjuvant to obesity surgery. Obes Surg 10(6):530–539CrossRef

15.

Rosen MJ, Aydogdu K, Grafmiller K, Petro CC, FaimaFn GH, Prabhu A (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19(8):1399–1406. https://doi.org/10.1007/s11605-015-2856-6CrossRef

16.

Zhu X, Herrera G, Ochoa JB (2010) Immunosuppression and infection after major surgery: a nutritional deficiency. Crit Care Clin 26(3):491–500. https://doi.org/10.1016/j.ccc.2010.04.004CrossRefPubMed

17.

Koolen PG, Ibrahim AM, Kim K, Sinno HH, Lee BT, Schneider BE, Jones DB, Lin SJ (2014) Patient selection optimization following combined abdominal procedures: analysis of 4925 patients undergoing panniculectomy/abdominoplasty with or without concurrent hernia repair. Plast Recontr Surg 134(4):539e-e550. https://doi.org/10.1097/PRS.0000000000000519CrossRef

18.

Elstner KE, Read JW, Saunders J, Cosman PH, Rodriguez-Acevedo O, Jacombs ASW, Martins RT, Ibrahim N (2020) Selective muscle botulinum toxin A component paralysis in complex ventral hernia repair. Hernia 24(2):287–293. https://doi.org/10.1007/s10029-019-01939-3CrossRefPubMed

19.

Khansa I, Janis JE (2018) Management of skin and subcutaneous tissue in complex open abdominal wall reconstruction. Hernia 22(2):293–301. https://doi.org/10.1007/s10029-017-1662-3CrossRefPubMed

20.

Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554CrossRef

21.

Breuing K, Butler CE, Ferzoco S et al (2010) The Ventral Hernia Working Group. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. https://doi.org/10.1016/j.surg.2010.01.008CrossRefPubMed

22.

Harth KC, Blatnik JA, Rosen MJ (2011) Optimum repair for massive ventral hernias in the morbidly obese patient—is panniculectomy helpful? Am J Surg 201:396–400. https://doi.org/10.1016/j.amjsurg.2010.08.023CrossRefPubMed

23.

Rasmussen RW, Patibandla JR, Hopkins MP (2017) Evaluation of indicated non-cosmetic panniculectomy at time of gynecologic surgery. Int J Gynaecol Obstet 138(2):207–211. https://doi.org/10.1002/ijgo.12207CrossRefPubMed

24.

Shubinets V, Fox JP, Tecce MG, Mirzabeigi MN, Lanni MA, Kelz RR, Dumon KR, Kovach SJ, Fischer JP (2017) Concurrent panniculectomy in the obese ventral hernia patient: assessment of short-term complications, hernia recurrence, and healthcare utilization. J Plast Reconstr Aesthet Surg 70(6):759–767. https://doi.org/10.1016/j.bjps.2017.01.001CrossRefPubMed

25.

Papadopulos NA, Staffler V, Mirceva V, Henrich G, Papadopoulos ON, Kovacs L, Herschbach P, Machens HG, Biemer E (2012) Does abdominoplasty have a positive influence on quality of life, self-esteem, and emotional stability? Plast Reconstr Surg 129(6):957e–962e. https://doi.org/10.1097/PRS.0b013e31824ecc2bCrossRefPubMed

26.

Rhemtulla IA, Hsu JY, Broach RB, Mauch JT, Serletti JM, DeMatteo RP, Fischer JP (2021) The incisional hernia epidemic: evaluation of outcomes, recurrence, and expenses using the healthcare cost and utilization project (HCUP) datasets. Hernia. https://doi.org/10.1007/s10029-021-02405-9CrossRefPubMed

27.

Naga HI, Mellia JA, Diatta F, Othman S, Patel V, Jnis JE, Heniford BT, Fischer JP (2020) Beyond the hernia repair: a review of the insurance coverage of critical adjuncts in abdominal wall reconstruction. Plast Reconstr Surg Glob Open 8(12):e3309. https://doi.org/10.1097/GOX.0000000000003309CrossRefPubMedPubMedCentral

Title: Is simultaneous panniculectomy an ideal approach to repair a ventral hernia: a general surgeon’s experience
Authors: K. Slater
A. A. Ajjikuttira
Publication date: 01-02-2022
Publisher: Springer Paris
Keywords: Obesity
Obesity
Published in: Hernia / Issue 1/2022
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-021-02483-9

At a glance: The STEP trials

Springer Medicine

Is simultaneous panniculectomy an ideal approach to repair a ventral hernia: a general surgeon’s experience

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Chronic pain after inguinal hernia repair is a real risk and a major issue

Comment to: Should seroma be considered a complication?

Perioperative outcome in groin hernia repair: what are the most important influencing factors?

Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals

Enhancing the hole in patients with hernia: Does single-site surgery make any sense?

Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction