Our experience confirms that radical resectional pelvic surgery can be safely performed with acceptable results during the establishment phase of a dedicated tertiary service.
General surgery patients were managed more efficiently with the RAMS unit in place. However, a full cost analysis is required to determine if such units are cost-effective.
mobility. A subgroup of obese patients with pannus are unfit for bariatric procedures and their pannus physically incapacitates them, making them unable to maintain levels of activity required for any weight loss. Another subgroup of patients with extreme obesity develop chronic inflammation or intertrigo and chronic wounds in an apron. Panniculectomy before a bariatric procedure may be considered in these patient populations. 3 Our patient fit both these subgroups. Complication rates following panniculectomy vary from 40% to 60% and include haematoma, seroma, abdominal flap necrosis or infections. 4,5 Our patient was challenging in every aspect of care of a morbidly obese patient. Challenges ranged from logistics, preoperative workup, anaesthetics, technical feasibility, surgical care, ICU and post-operative care. Surgery at our hospital (as transfer was not an option) was the only way forward to prevent recurrent lifethreatening infections and improve quality of life for this patient.
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