Panniculectomy to Facilitate Gynecologic Surgery in Morbidly Obese Women

Powell, John L.; Kasparek, Dorigen K.; Connor, G. Patrick

doi:10.1097/00006254-200002000-00014

Cited by 1 publication

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“…However since this was a retrospective survey at a single institution, there was no cohort to compare these outcomes to a sample that had gynecologic surgery alone. Powell et al 6 also reported a series of 20 morbidly obese patients that underwent panniculectomy with gynecologic surgery, with only 3 patients experiencing partial wound dehiscence, and thus concluded that abdominal panniculectomy is safe and useful in morbidly obese women. Yet, this study demonstrated the outcomes of a single institution outcome with a small sample size of 20 women, lacking any comparative cohort.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the literature contains many reports promoting the combination of panniculectomy with gynecologic surgery 1–5 . Proponents of panniculectomy with various gynecologic surgeries argue that it improves the safety of these operations by decreasing complications and improving outcomes in this patient population 1,6,7 . However, most of these studies lack comparative cohorts of patients operated on by the same surgeons with sample size sufficient for proper statistical comparison.…”

mentioning

confidence: 99%

“…[1][2][3][4][5] Proponents of panniculectomy with various gynecologic surgeries argue that it improves the safety of these operations by decreasing complications and improving outcomes in this patient population. 1,6,7 However, most of these studies lack comparative cohorts of patients operated on by the same surgeons with sample size sufficient for proper statistical comparison. One patient variable in the literature, which has been demonstrated to be consistently associated with increased intraoperative and postoperative morbidities, is morbid obesity.…”

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confidence: 99%

See 2 more Smart Citations

Panniculectomy Performed in Conjunction With Gynecologic Surgery in Obese and Morbidly Obese Patients

Nag¹,

Patel²,

Gaughan

et al. 2021

Ann Plast Surg

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Introduction Panniculectomy is a common procedure in plastic surgery, often performed after massive weight loss and in morbidly obese patients. It is also performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates and benefit the patient (Am J Obstet Gynecol, 2000. 182, 1502–1505; J Gynecol Technol, 1997;3:9–16; J Am Coll Surg, 1995). These and other studies fail to provide proof of these claims for a number of reasons, including study design, lack of a control group and the inclusion of nonmorbidly obese patients (J Am Coll Surg, 1995; Gynecol Oncol, 1998, 70, 80–86; Int J Gynecol Cancer, 2015;25(8):1503–1512). Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving toward penalizing practices, which increase complications. The aim of this study was to evaluate the premise that the addition of panniculectomy to gynecologic surgery in the obese and morbidly obese patient population results in a statistically significant improvement in measureable outcomes. Methods/Results The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to assess the association of complications with panniculectomy combined with gynecologic surgery in the morbidly obese patient population. The query identified 296 patients with a body mass index greater than 30 who had panniculectomy concomitant with gynecologic surgery. The results demonstrated a statistically significant relationship (P < 0.05) of these concomitant procedures with superficial infection, wound infection, pulmonary embolism, systemic sepsis, return to operating room, length of operation and length of stay. A systematic review of the literature was then performed which identified only 5 studies that included comparative cohorts of those with gynecologic surgery, with and without panniculectomy. There was no significant benefit across the studies in measured paramters. Conclusions This NSQIP study and systematic review of the existing literature does not support the premise that there is a statistically significant benefit associated with performing panniculectomy in conjunction with gynecologic surgery in the morbidly obese patient population. The NSQIP data demonstrate significant elevation of negative outcomes in morbidly obese patients undergoing combined procedures. In the light of the risks to patients and current direction of medical practice the addition of elective panniculectomy to gynecologic surgery should be reevaluated in the a patient population with a body mass index greater than 30.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%