Transverse periumbilical incision in the massively obese patient

A periumbilical transverse incision placed above or no more than 5 cm below the external portion of the umbilicus was used for pelvic surgery in 21 massively obese women with a large dependent panniculus. Five patients (24%) had wound complications of varying degrees, including one evisceration. Other complications included postoperative fever (62%), urinary tract infection (19%), respiratory complications (10%), paralytic ileus (5%), partial small bowel obstruction (5%), and pulmonary embolus (5%). There was no operative mortality in the series. The periumbilical approach gives good exposure during surgery and--in the patient population studied--is preferable to other incisions for pelvic surgery. It circumvents the contaminated suprasymphyseal problem area beneath the pannicular fold and avoids the thick, edematous, dependent portion of the panniculus, which must be retracted upward for low and high suprasymphyseal transverse and midline abdominal incisions.