Postoperative Outcomes in Obese Patients that Undergo Ventral Hernia Repair vs. Ventral Hernia Repair with Concurrent Panniculectomy

Background: The safety of concurrent panniculectomy during ventral hernia repair (VHR-PAN) remains a widely debated topic. This study aims to compare outcomes in obese patients who undergo VHR-PAN versus ventral hernia repair (VHR) alone to guide surgeons on whether to perform a panniculectomy during ventral hernia repair. Methods: An eight-year retrospective cohort study was performed on obese patients who underwent VHR. Patients were divided into those who received a concurrent panniculectomy and those who did not. Postoperative complications were compared between these groups. Complications were subdivided into surgical site occurrences (SSO), surgical site occurrences that required an intervention (SSOPI), unplanned return to the operating room, and hernia recurrence. Results: A total of 223 patients were analyzed; 122 in the VHR-PAN group and 101 in the VHR-only group. Median follow-up duration was 141 days. Patients in the VHR-PAN group had more SSO (57% vs. 40%, p=0.012). Both groups had similar rates of SSOPI (39% vs 31%, p=0.179), unplanned return to the operating room (25% vs 18%, p=0.173), and hernia recurrence (23% vs 29%, p=0.326). Multivariate analysis showed that concurrent panniculectomy increased the risk of SSO by two-fold, however it did not increase the risk of SSOPI or return to the operating room. Conclusions: The addition of a panniculectomy to ventral hernia repair increases surgical site occurrences however does not increase complications that require an intervention. As such, VHR-PAN can be considered in obese patients with a symptomatic panniculus who wish to have a single-stage operation and the lifestyle benefits of a panniculectomy. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: Yvonne M. Rasko, MD, 22 South Greene St, S8D18, Baltimore, Maryland 21201 USA YRasko@som.umaryland.edu ©2019American Society of Plastic Surgeons

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