Panniculectomy with Simultaneous Ventral Hernia Repair: A Retrospective Analysis of Surgical Outcomes

Background:

Panniculectomy (PAN) and ventral hernia repair (VHR) are major abdominal surgeries that carry inherent risk. In cases where both procedures are indicated, there is limited and conflicting evidence that addresses the safety of performing the two simultaneously. In this study, we investigated clinical outcomes associated with PAN and PAN with concomitant VHR over an eight-year period at a single institution.

Methods:

Using CPT codes, we retrieved hospital records of all patients who underwent PAN alone or PAN+VHR at our institution between 2007 and 2014. Charts were reviewed for patient demographics, operative technique, hospital readmissions, and post-operative complications including, but not limited to, surgical site infection, wound dehiscence, hematoma, seroma, and skin necrosis. Chi-squared tests were used to compare unadjusted marginal differences for categorical variables between groups, and Wilcoxon rank sum tests were used to compare unadjusted marginal differences for continuous variables.

Results:

We identified 58 patients who underwent PAN alone and 41 who underwent PAN+VHR. Patients in the two groups were demographically similar with no significant differences. Mean length of follow-up was 7 and 15 months, respectively (p=0.23). Patients who underwent PAN+VHR had an increased risk of developing cellulitis post-operatively (29.3% vs. 10.2%; p=0.02). Overall risk of post-operative complications, however, was not significantly increased (p=0.22). PAN+VHR patients also had an increased risk for related emergency room (ER) visit within 1 year of discharge (29.3% vs. 12.1%; p=0.03). Risk of readmission within the same time frame was not significantly increased (p=0.25). Among patients who underwent PAN+VHR, hernia size was positively associated with an increased risk of related ER visit (p=0.01) and 1-year readmission (p=0.02). Additionally, the implantation of mesh in PAN+VHR patients was positively associated with an increased risk of post-operative complication (p=0.02) and 1-year readmission (p=0.04).

Conclusions:

In our study, patients who underwent PAN+VHR were found to have an increased risk of cellulitis and related ER visit within 1 year of discharge. The actual magnitude of risk varies depending on the patient, and is likely influenced by individual comorbidities as well as hernia size and complexity. Further investigations that compare patient outcomes following PAN+VHR and VHR alone are indicated to evaluate the extent to which the findings presented here may be attributed to hernia repair alone.