Supersize panniculectomy: a case report

Morbid obesity can present with life-limiting panniculus morbidus, a severe excess of abdominal tissue. We describe the importance of a multidisciplinary, tailored surgical approach involving the resection of 30 kg of tissue to achieve both functional and psychological recovery, despite high perioperative risks.

A 47-year-old man [body mass index (BMI) 61] presented with a pendulous pannus extending to the knees, leading to urinary and sexual dysfunction, recurrent skin infections, ulcerations, and inability to perform daily activities. He underwent an elective, two-stage panniculectomy. Intraoperatively, two supraumbilical hernias and aberrant lymphovascular clusters were identified. A total of 30 kg of tissue was removed. Closure employed progressive-tension sutures and negative-pressure dressings. Postoperatively, he developed a seroma and transient urinary incontinence, both managed conservatively. By 1 month, he had regained independence in activities of daily living and demonstrated marked psychological improvement.

Resection of 30 kg of pannus qualifies as a "supersize" panniculectomy. Common complications - seromas and wound dehiscence - are more frequent in patients with a high BMI and comorbidities such as diabetes and smoking. However, with meticulous planning and technique, this case shows that even high-risk patients can achieve meaningful functional restoration and quality-of-life gains.

Amid the global obesity epidemic, this report advocates for a flexible, function-driven surgical strategy in extreme cases typically deemed ineligible for intervention. When needed, panniculectomy can deliver substantial benefits that outweigh the inherent risks.