M. P. Lundgren1, C. Kustera1, D. G. McKeown1, E. G. Rosato1, F. Palazzo1, K. A. Chojnacki1, M. Jenkins1, P. J. Greaney1 1Thomas Jefferson University Hospital,General Surgery,Philadelphia, PA, USA
Introduction: Panniculectomy at the time of abdominal wall reconstructionis controversial, with current reviews reporting higher surgical site occurrences (SSO) when included. At our institution we prefer anterior component separation (ACS) and Phasix mesh onlay for AWR, and panniculectomy for patients with pannus. Herein, we compare perioperative, SSO and recurrence rates at our institution after our preferred AWR method with and without panniculectomy.
Methods: Data was gathered retrospectively. Statistical analysis was performed using Fisher’s exact test to determine significance of difference with or without panniculectomy for SSO and perioperative outcomes, and readmission. Student’s t-test was used to evaluate differences between operative time (OT) and length of stay (LOS).
Results: 175 patients who underwent AWR between September 2014-June 2017 were included. 59 patients underwent AWR with panniculectomy. The mean OT for the panniculectomy group was 4.1 hours versus 3.4 without (p=0.07). The mean LOS for the panniculectomy group was 4.4 days versus 3.4 without (p= 0.02). There were no significant differences in SSO or readmission (See table below). The recurrence rate in the panniculectomy group was 12% (7/59), with a mean time to recurrence of 1.4 years. This was not significantly different from the 17% recurrence rate without panniculectomy (p=0.38), with a mean time to recurrence of 1.5 years.
Conclusion: Patients who undergo AWR with ACS and Phasix onlay mesh placement, the choice to perform panniculectomy should be based on discussion between the surgeon and patient, as there are no significant differences between SSO or recurrence rates.
