Abdominal Panniculectomy in Super Obese Patients

David J. Rowe

ANATOMY

PATIENT HISTORY AND PHYSICAL FINDINGS

The preoperative evaluation for a patient with super obese panniculus includes a detailed history as well as documentation of pertinent physical manifestations.
Physical examination
- Large abdominal panniculus
- Intertriginous rashes
- Chronic infection
- Ulcerations
- Fistulous tracts
- Physical limitation
- Presence of hernia: difficult given overlying tissue

IMAGING AND OTHER DIAGNOSTIC STUDIES

If hernia is suspected, CT scan with contrast is warranted (FIG 1).

FIG 1 • A. Presence of hernia on CT scan. B. Intraoperative view of hernia.
Preoperative laboratory values: patients who have had previous gastric bypass will need a preoperative workup that will be discussed more in detail in other chapters. Given the likely comorbidities of the super obese, nutritional parameters may also be evaluated in the workup of all patients.
- Nutritional parameters: albumin, prealbumin
- Lab workup: CBC, basic chemistry

NONOPERATIVE MANAGEMENT

The primary decision in the instance of panniculectomy in the super obese patient is the possibility of weight loss or gastric bypass prior to surgery.¹
- In the case of panniculus morbidus, the pannus may still be present following weight loss.²
- In the case of combined surgery for cancer extirpation, etc., ideal weight loss may not be achieved.