Outcomes of Concurrent Panniculectomy and Hernia Repair in a Single Surgeon’s Abdominal Wall Reconstruction Practice

Background Concurrent panniculectomy (CP) with hernia repair allows patients to have removal of their redundant skin and excess overlying fat in addition to herniorrhaphy. While providing excellent cosmesis and patient satisfaction, concerns have historically included longer operative times, higher rates of wound complications and infection. This study analyzed the rates of postoperative complications in patients undergoing CP with abdominal wall reconstruction (AWR). Methods A prospectively maintained institutional database was queried for patients who underwent both hernia repair and CP. All patients had the same fellowship trained surgeon, between 2017 and 2023. Primary outcomes included wound complications and hernia recurrence rates. Results A total of 149 patients were identified; 75.8% were female, mean age was 57.3 ± 12.2 years, median BMI was 32.2 kg/m2 (IQR:28.4, 36.5), 30.9% had diabetes, 14.8% were immunosuppressed, and 5.4% were smoking. Prehabilitation resulted in a median preoperative weight loss of 11.7 lbs (IQR:21.7, 1.0). Median hernia size was 216.0 cm2 (IQR:150.0, 300.0), and 97.3% were ventral hernias. Median mesh size was 900.0 cm2 (IQR:471.2, 1050.0), 57.7% were biologic, and 98.7% of all repairs had preperitoneal mesh placement. Intraoperatively, 83.2% of cases were clean or clean-contaminated. Median operative time was 134.5 minutes (IQR:110.0, 176.0). Postoperative wound complications included seroma requiring intervention (11.4%), cellulitis (7.4%), wound infection (6.0%), intraabdominal abscess (6.0%), wound breakdown (3.4%), hematoma requiring intervention (3.4%), and mesh infection (1.3%). Hernia recurrence rate was 2.0% over a median follow-up time of 16.4 months (IQR:5.7, 41.1). Conclusion CP with AWR does not compromise wound morbidity or hernia recurrence. Despite significant patient comorbidities, rates of postoperative wound morbidity were low.