The abdominal pannus is a stomach deformity where any amount of tissue hangs over the waistline. The term, pannus, is derived from a latin word for apron so it is fitting that any overhang is referred to as such. In days before bariatric surgery, abdominal panniculectomy surgery was very common and it was almost always associated with morbid obesity. Because of bariatric surgery, the most common abdominal panniculectomy today is much smaller and is done after large amounts of weight loss. These pannuses are largely skin and the overall health of the patient is generally good since they are more weight appropriate for their height.
But despite the popularity and widespread availability of bariatric surgery, not every obese patient undergoes it or is eligible to do so. This still leaves certain patients who are overweight that suffer from a large pannus with all of its associated symptoms. There has been some understandable reluctance to operate on such overweight patients due to the increased risk of complications that is known to occur .
In the October 2014 issue of the Annals of Plastic Surgery, an article was published entitled “Supersize” Abdominal Panniculectomy: Indications, Technique, and Results’. In this paper, the authors reviewed a series of 26 patients over a six year period that had abdominal panniculectomies performed that weighed over 10 kgs. (22 lbs), hence the term supersized pannus. The indications for surgery were typical including a large amount of overhanging abdominal skin and fat (hangs down to mid-thigh level) that was associated with underlying chronic skin infections, history of panniculitis, and the presence of a hernia. Of the 26 patients, the mean pannus weight removed was over 15 kgs with a followup period of over a year. The overall wound complication rate for the “supersize” panniculectomy over 40%. (11/26 patients). The rate of major complications, defined as those complications requiring a return to the operating room, was just over 10%. (3/26 patients).
The relevance of this paper is that it demonstrates that larger abdominal panniculectomies can be done and offer a dramatic improvement in mobility and function of the patient. However, it creates a large abdominal incision and has a lot of ‘dead space’ inside to heal. As a result, wound complications are common (and to be largely expected) and revisits to the operating room for their management are not rare. This type of abdominal surgery should be confused in this regard with the more common tummy tuck. A CT scan done before surgery can help discover a hernia which can be very difficult if not impossible to pick up on a physical examination of a large pannus.
This paper of larger abdominal panniculectomies supports what I tell my patients…the operation will be highly successful and can be life-changing but there is a very high incidence of wound complications and the need for further surgery/hospitalization is not rare. In the long run it will be very much worth it but expect a healing period of two to three months for a full recovery.
Dr. Barry Eppley
Indianapolis, Indiana