INTRODUCTION: A large hanging pannus can cause problems like intertrigo, chronic infection, and immobility. Many patients undergoing weight reduction surgery can benefit from panniculectomy to improve their functional outcome. This can be done either at the same time with bariatric surgery or after an interval of weight loss. The aim of this retrospective study was to evaluate the outcome of patients undergoing panniculectomy as an adjuvant to bariatric surgery. METHODS: Over the last five years we performed 123 panniculectomies on patients (34 males, 89 females / mean age 44.5±10.3 years) undergoing bariatric surgery. The panniculectomy was either done at the same time with the bariatric surgery [Group I=21 patients] or after a time period (17.7±11.1 months) following the bariatric surgery [Group II=102 patients]. Ninety-two percent of the patients had multiple comorbidities. Paired t-test, unpaired t-test and Fisher’s exact test were used for statistical analysis. RESULTS: Patients who had panniculectomy simultaneously with the bariatric surgery [Group I] had a higher average BMI than the patients who had panniculectomy after their bariatric surgery [Group II] (60.47±13.77 vs. 39.95±9.33, p<0.05). Patients in group II had an average of 66.13±41.33 kg weight loss following bariatric surgery. Overall, group I patients had higher rates of complications than group II patients. The rate of complications were; wound infections 48% vs.16% (p<0.05), dehiscence 33% vs. 13% (p<0.05), respiratory distress 24%. vs. 0% (p<0.05) and death 14% vs. 0% respectively. The rates of skin necrosis (10% vs. 6%) and hematoma formation (10% vs. 2%) were also high although these were not statistically significant. The average length of hospital stay was longer in group I patients (8.86±6.73 days) than in group II patients (3.12±2.04 days) (p<0.05). Patients who underwent separation of parts as a part of their panniculectomy also had higher wound complications compared to panniculectomy alone. Additional cosmetic body contouring procedures (thighplasty, reduction mammaplasty, brachioplasty and augmentation mammaplasty) were performed in 15% of group II patients. Overall 44% of the patients had incisional hernias due to laparotomy for bariatric surgery. In group II patients these were repaired at the time of panniculectomy. Reoperation to remove more fat tissue and redundant skin from the abdomen was more common in group I patients than in group II patients (20% vs. 4%, p<0.05). CONCLUSION: Panniculectomy is a safe procedure in morbid obesity with long term functional improvement. Performing the panniculectomy after an interval of weight loss has several benefits over the simultaneous procedure. There is less morbidity with lower rate of complications and shorter hospital stay. Since the weight loss has reached a plateau the amount of tissue removed can be final compared to patients who will have ongoing weight loss with more redundant skin following a simultaneous procedure. Any incisional hernias that occur as a result of initial bariatric surgery can be repaired at the time of panniculectomy. In conclusion, most patients will do best with panniculectomy performed as a separate procedure after weight loss has reached a plateau.