Simultaneous Abdominal Wall Reconstruction and Panniculectomy in High-Risk Complex Patients: A Retrospective Cohort Study.

Abstract

<h4>Introduction</h4>Ventral hernia repair (VHR) in high-risk, complex obese patients often presents a technical challenge for surgeons. Performing a panniculectomy (PAN) at the same time as the VHR may be an acceptable option for enhancing hernia exposure, improving cosmetic outcomes, and improving subsequent quality of life (QoL). However, this approach remains controversial due to the theoretical increase in postoperative complications. The objective of this study was to evaluate the relevance of combining PAN with VHR in complex obese patients in a specialised centre in France.<h4>Materials and methods</h4>A retrospective single-arm study was conducted, including all patients who underwent VHR with PAN from January 2020 to December 2024 at a high-complexity referral hernia centre in Reims, France. Preoperative, intraoperative, and postoperative data were collected and analysed. Complications were categorised according to the Surgical Site Occurrences (SSOs), Surgical Site Infections (SSIs) and Clavien-Dindo classifications. Emergency hernia repairs were excluded.<h4>Results</h4>A total of 45 patients were included. The maximum median BMI was 40.26 kg/m². All patients had at least one comorbidity, more than half had a loss of domain or a stoma, and more than 70% were classified as 2 or 3 according to the VHWG classification. The component separation technique was necessary for 42% of patients. The SSO and SSI rates were 58% and 7%, respectively, with an unplanned reoperation rate of 15%. After a median follow-up of 31 weeks, 11% of patients developed a hernia recurrence.<h4>Conclusion</h4>Combining PAN with VHR in complex obese patients increases the risk of minor wound complications but does not significantly affect the rate of major complications or recurrence. PAN may introduce additional morbidity for complex VHR in obese patients and should be considered in selected cases after a thorough risk-benefit evaluation.