Concomitant Panniculectomy During Ventral Hernia Repair: Outcomes From a High-Volume Abdominal Wall Reconstruction
Thomas G Mackay1,2, Jai Hoff1, Tahera Ahmed1,3
1Abdominal Wall Reconstruction Unit, University of Queensland, Princess Alexandra Hospital, and Greenslopes Private Hospital, Brisbane, Australia.
Background:
Concomitant panniculectomy during ventral hernia repair (VHR) remains controversial due to concerns about wound morbidity. Potential benefits include improved operative exposure and reduced abdominal wall strain. This study evaluated outcomes of VHR with and without panniculectomy in a specialised abdominal wall reconstruction unit.
Methods:
A retrospective analysis of a prospectively maintained database of consecutive adult patients undergoing VHR with or without panniculectomy was performed. The primary outcome was hernia recurrence. Secondary outcomes included surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), mesh infection, and length of stay (LOS). Propensity-score overlap weighting adjusted for measured differences between cohorts. Time-to-recurrence was assessed using Kaplan-Meier analysis.
Results:
A total of 819 patients were included (VHR: n = 341; VHR + PAN: n = 478). The VHR + PAN group was younger, more often female, had higher BMI, fewer smokers, and more botulinum toxin use. Crude hernia recurrence was lower in VHR + PAN (5.6% vs. 14.7%, p < 0.001), though wound morbidity was higher (SSO: 26.4% vs. 14.1%, p < 0.001; SSOPI: 17.2% vs. 11.7%, p = 0.040). After overlap weighting, panniculectomy remained associated with lower recurrence (aOR 0.42, 95% CI 0.19-0.95; p = 0.037) and higher SSO (aOR 2.14, 95% CI 1.18-3.89; p = 0.012), but no significant difference in SSOPI (aOR 1.28, 95% CI 0.66-2.47; p = 0.461). LOS was longer in VHR + PAN (adjusted ratio 1.16, 95% CI 1.07-1.27; p < 0.001). Kaplan-Meier analysis confirmed higher recurrence-free survival in VHR + PAN (log-rank p = 0.001).
Conclusion:
Concomitant panniculectomy was associated with lower hernia recurrence but higher wound morbidity and longer LOS. These findings support its feasibility in selected patients, though the observational design limits causal inference.