Hernia Surgery pp 297-306 | Cite as

Panniculectomy: Tips and Tricks to Maximize Outcomes

  • Karan ChopraEmail author
  • Devinder Singh


Obese patients with the presence of a large abdominal pannus often suffer from wound healing complications after undergoing ventral hernia repair. However, concomitant panniculectomy can result in fewer major wound complications and improve surgical exposure during repair when performed in the appropriate patient and with proper technique. [1, 2] After reading this chapter, the readers should be able to select appropriate patients for concomitant panniculectomy, understand the benefits of simultaneous panniculectomy, and understand how to perform the panniculectomy safely to optimize surgical outcomes.


Panniculectomy Ventral hernia repair Wound healing Concomitant panniculectomy 

Supplementary material

Video 28.1

Panniculectomy at the time of AWR, by Singh (MP4 206,767 kb)


  1. 1.
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Petty P, Manson PN, Black R, Romano JJ, Sitzman J, Vogel J. Panniculus morbidus. Ann Plast Surg. 1992;28(5):442–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Demars M, Marx M. Surgical treatment of obesity. Prog Med. 1890;11:283.Google Scholar
  4. 4.
    Kelly H. Excision of the fat of the abdominal wall lipectomy. Surg Gynecol Obstet. 1910;10(229):18.Google Scholar
  5. 5.
    Shermak MA. Hernia repair and abdominoplasty in gastric bypass patients. Plast Reconstr Surg. 2006;117(4):1145–50; discussion 1151–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Iljin A, Szymanski D, Kruk-Jeromin J, Strzelczyk J. The repair of incisional hernia following roux-en-Y gastric bypass-with or without concomitant abdominoplasty? Obes Surg. 2008;18(11):1387–91.CrossRefPubMedGoogle Scholar
  7. 7.
    Koolen PG, Ibrahim AM, Kim K, et al. Patient selection optimization following combined abdominal procedures: analysis of 4925 patients undergoing panniculectomy/abdominoplasty with or without concurrent hernia repair. Plast Reconstr Surg. 2014;134(4):539e–50e.CrossRefPubMedGoogle Scholar
  8. 8.
    Saxe A, Schwartz S, Gallardo L, Yassa E, Alghanem A. Simultaneous panniculectomy and ventral hernia repair following weight reduction after gastric bypass surgery: is it safe? Obes Surg. 2008;18(2):192–5; discussion 196.CrossRefPubMedGoogle Scholar
  9. 9.
    Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT. Predictors of wound infection in ventral hernia repair. Am J Surg. 2005;190(5):676–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Krupski WC. The peripheral vascular consequences of smoking. Ann Vasc Surg. 1991;5(3):291–304.CrossRefPubMedGoogle Scholar
  11. 11.
    Moore KL, Dalley AF, Agur AM. Clinically oriented anatomy. Philadelphia: Lippincott Williams & Wilkins; 2013.Google Scholar
  12. 12.
    Huger Jr WE. The anatomic rationale for abdominal lipectomy. Am Surg. 1979;45(9):612–7.PubMedGoogle Scholar
  13. 13.
    Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Chopra K, Tadisina KK, Conde-Green A, Singh DP. The expanded inframammary fold triangle: improved results in large volume breast reductions. Indian J Plast Surg. 2014;47(1):65–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Le Louarn C, Pascal JF. High superior tension abdominoplasty. Aesthetic Plast Surg. 2000;24(5):375–81.CrossRefPubMedGoogle Scholar
  16. 16.
    Le Louarn C, Pascal J. High superior tension abdominoplasty—a safer technique. Aesthet Surg J. 2007;27(1):80–9.CrossRefGoogle Scholar
  17. 17.
    Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105(7):2583–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Conde-Green A, Chung TL, Holton 3rd LH, et al. Incisional negative-pressure wound therapy versus conventional dressings following abdominal wall reconstruction: a comparative study. Ann Plast Surg. 2013;71(4):394–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Wang H, Singh D. The use of indocyanine green angiography to prevent wound complications in ventral hernia repair with open components separation technique. Hernia. 2013;17(3):397–402.CrossRefPubMedGoogle Scholar
  20. 20.
    Gurtner GC, Jones GE, Neligan PC, et al. Intraoperative laser angiography using the SPY system: Review of the literature and recommendations for use. Ann Surg Innov Res. 2013;7(1):1.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Holm C, Mayr M, Höfter E, Becker A, Pfeiffer U, Mühlbauer W. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg. 2002;55(8):635–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Erba P, Ogawa R, Ackermann M, et al. Angiogenesis in wounds treated by microdeformational wound therapy. Ann Surg. 2011;253(2):402–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Atkins BZ, Tetterton JK, Petersen RP, Hurley K, Wolfe WG. Laser doppler flowmetry assessment of peristernal perfusion after cardiac surgery: beneficial effect of negative pressure therapy. Int Wound J. 2011;8(1):56–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R. Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery: a review of evidence and mechanisms for an emerging indication. Bone Joint Res. 2013;2(12):276–84.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Wilkes RP, Kilpad DV, Zhao Y, Kazala R, McNulty A. Closed incision management with negative pressure wound therapy (CIM): biomechanics. Surg Innov. 2012;19(1):67–75.CrossRefPubMedGoogle Scholar
  26. 26.
    Kairinos N, Solomons M, Hudson DA. Negative-pressure wound therapy I: the paradox of negative-pressure wound therapy. Plast Reconstr Surg. 2009;123(2):589–98; discussion 599–600.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Plastic SurgerySchool of Medicine, Johns Hopkins UniversityBaltimoreUSA
  2. 2.Chief of Plastic SurgeryAnne Arundel Medical CenterAnnapolisUSA

Personalised recommendations