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Optimizing Ventral Hernia Repairs With a Concomitant Panniculectomy: A Combined Approach Using Component Separation

Hector Caceres1, Luke Anderson1, Alexandra Savage1

  • 1From the University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL.

Annals of Plastic Surgery
|May 19, 2025
PubMed
Summary

Combining ventral hernia repair (VHR) with panniculectomy (PAN) using acellular dermal matrix (ADM) showed no recurrences in a 10-year study. This approach offers functional and aesthetic benefits with manageable complications for complex hernia cases.

Keywords:
component separationonlaypanniculectomyventral hernia repair

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Area of Science:

  • Surgical Innovation
  • Hernia Repair Techniques
  • Reconstructive Surgery

Background:

  • Concomitant panniculectomy (PAN) during ventral hernia repair (VHR) is debated due to potential complications.
  • PAN offers advantages like improved exposure, quality of life, and aesthetics.
  • The senior author's technique involves component separation with onlay acellular dermal matrix (ADM) and progressive quilting sutures.

Purpose of the Study:

  • To evaluate the outcomes of patients undergoing VHR + PAN using component separation technique with onlay ADM placement.
  • To assess the safety and efficacy of this combined approach for complex ventral hernias.

Main Methods:

  • Single-center retrospective analysis of 29 patients over 10 years.
  • Inclusion criteria: VHR + PAN, component separation, onlay ADM, and ≥6 months follow-up.
  • Exclusion criteria: no onlay ADM or <6 months follow-up.

Main Results:

  • No hernia recurrences observed over an average follow-up of 21.3 months.
  • Most patients were obese (79.3%) and had prior hernia repairs (82.8%).
  • Common complications: seromas (34.4%), wound necrosis (20.7%), and infection (6.9%).

Conclusions:

  • VHR + PAN with component separation and onlay ADM is safe and effective for complex hernias.
  • This approach provides functional, aesthetic, and quality-of-life benefits, reducing the need for multiple surgeries.
  • Further multicenter studies are warranted to validate outcomes and optimize complication management.