Panniculectomy in the Massive Weight Loss Patient: Restoration of Form and Function

Introduction: As the number of massive weight loss patients increases, more patients are presenting for body contouring procedures; the most common of which is panniculectomy or abdominoplasty. Panniculectomy is often performed to improve function, while cosmetic “add-ons” such as rectus abdominis plication are often considered to improve form. Whether abdominal plication alters the safety profile or increases operative time in this population remains to be determined.   

Methods:  48 consecutive massive weight loss patients (≥50lbs weight loss) underwent abdominal contouring procedures and were enrolled in our prospective registry. Plication use was determined intra-operatively based on the degree of abdominal wall laxity. Patients were assessed for use of plication, resection weight, operative time, and concomitant procedures. Post-operative complications including seroma, hematoma, delayed wound healing, DVT, and PE were compared between the groups. Multivariate regression analysis was performed to determine the influence of plication on the total number of complications.

Results: 20 (31%) underwent plication (Group 1) and 28 (69%) did not (Group 2). Patient demographics and clinical characteristics were compared between the groups in Table 1. Max BMI and Delta BMI did not differ between the groups. Mean Current BMI (p=0.0261) and resection weights (p=0.0324) were greater in Group 2. Operative time and post-operative complications did not differ between the groups.  When controlling for age, gender, current BMI, number of concomitant procedures, resection weight, and operative time, patients with plication were not found to have an increased number of complications (p=0.4893).

Conclusions:  Abdominal rectus plication was not associated with an increase in mean operative time or complication profile. Thus, rectus plication in the massive weight loss population can be used at the discretion of the body contouring surgeon to improve abdominal form and function in a safe and effective manner.
Table 1: Demographics and Clinical Characteristics

Characteristics	Group 1 N=20 (with plication)	Group 2 N=28 (without plication)	p value
Gender (female/male)	19/1	18/10	0.0126
Age	45.1±9.4	47.3±13.1	0.5212
# of Concomitant Procedures	4.0±1.1	2.9±1.2	0.0011
# of Complications	0.7±1.0	0.5±0.7	0.3619
Suture Abscess (yes/no)	1/19	0/28	0.2318
Suture Extrusion (yes/no)	2/18	1/27	0.3643
Wound Infection (yes/no)	2/18	3/25	0.9363
Hematoma (yes/no)	0/20	1/27	0.3931
Fat Necrosis (yes/no)	1/19	0/28	0.2318
Wound Dehiscence (yes/no)	1/19	3/25	0.4801
Seroma (yes/no)	6/14	5/23	0.3237
Chronic Pain (yes/no)	1/19	0/28	0.2318
Max BMI	52.6±10.4	58.4±13.0	0.1086
Current BMI	31.6±5.0	37.4±12.0	0.0261
Delta BMI	21.1±7.7	20.6±6.9	0.8345
Resection Weight (kg)	3.3±1.9	6.6±6.7	0.0324
Operative Time	228.2±278.3	165.9±195.4	0.4707