Introduction: A panniculectomy can be a pragmatic approach to improve function in obese and massive weight loss patients with significant symptomatic truncal obesity or skin laxity. Typically this operation is designed as a horizontally-oriented ellipse of skin and fat resection from the lower anterior abdomen, without undermining, which allows direct skin closure. Although successful, this approach addresses only one dimension of a multidimensional problem;  dissatisfaction exists with regard to redundant horizontal laxity of skin. The vertical panniculectomy offers a solution to this vis-à-vis a partial vertically-oriented ellipse excised superomedially that allows closer approximation of the horizontal skin dimensions. Outcomes with this approach are discussed.
Methods: Following IRB approval, we identified all patients who underwent panniculectomies at the University of Michigan from 2005 to 2008 by the senior author. These operations were identified as traditional horizontal (HP) panniculectomies or those with a vertical component (HP+V) and the patients were further separated into Obese and Massive Weight Loss (MWL) groups.  A retrospective chart review obtained demographic data, medical histories, BMI, pre-operative weight loss, comorbidities, hospitalization data, complications and follow-up care.  This paper is presented as a controlled case series comparing vertical to horizontal panniculectomy in these 2 patient populations.
Results: 34 sequential HP+V patients were identified and matched with 33 HP patients. The average age was 47.3±11.3 years. The average weight was 112.0±48kg with an average BMI of 40.7±16.8.  MWL patients previously lost an average of 63.5±40.3kg. The average MWL patient BMI was 35.1±13.5, and in the obese, 47.5±20.7 (extreme obesity).  Obese patients most often cited cosmetic symptoms (56%), followed by difficulty with ADL’s (26%), Low back pain (18%) and rash (18%). 33% of these patients had evidence of hernias. MWL patients most often complained of rash (65%), with similar rates of LBP and ADL difficulty.  There were no demographic, or symptomatic differences when comparing the overall HP and HP+V groups. HP patients had an average Length of Stay (LOS) of 4.3±4.9 days whereas HP+V patient LOS was 7.9±11.7 days. Notably, the obese patients who underwent HP+V had the longest LOS (13.5±15.5 days) and MWL patients who underwent HP+V had the shortest LOS (3.4±4.0 days). Complications included infections, seromas, and minor wound dehiscence. The complication rate was 30% in obese, and 48% in MWL patients.  The complication rate is highest in MWL patients who underwent HP (57%). The most common reason for reoperation was seroma, and this rate was again highest in MWL patients who underwent HP (24%). In HP patients the seroma rate is 15%, but this is reduced to 3% in HP+V. Overall, HP is associated with a 45±17% complication rate whereas HP+V has a 35±16% rate (95% confidence). Average number of follow-up appointments was 8.2±6.2 following HP and 6.3±5.1 following HP+V. No major dehiscence or skin loss was encountered in any group.
Conclusions: In this series, vertical panniculectomies demonstrated comparable complication rates to horizontal panniculectomies alone. Adding this relatively simple vertical element to the procedure offers a robust treatment option for those patients seeking a better body contour than can be offered by traditional horizontal panniculectomy.