Postoperative Outcomes of Panniculectomy With and Without Concomitant Ventral Hernia Repair: A National Cohort Analysis
Poster #: 099
Session/Time: B
Author:
Margaret Hope West, BA
Mentor:
Lawrence B. Colen, MD FACS
Research Type: Clinical Research
Abstract
INTRODUCTION:
Patients with obesity or massive weight loss often present with a symptomatic pannus and may also require abdominal wall reconstruction for concomitant ventral hernias. Previous studies compared panniculectomy with ventral hernia repair (PAN+VHR) to hernia repair alone, often noting higher complication rates. However, the more extensive intervention is typically the panniculectomy (PAN) itself. Direct comparisons between PAN alone and PAN+VHR remain limited, despite the morbidity associated with PAN. We aimed to compare postoperative outcomes of PAN versus PAN+VHR, hypothesizing that adding VHR would not increase complication rates.
METHODS:
We conducted a retrospective cohort study using the TriNetX National Health Research Network. Data were obtained through institutional access to TriNetX, a global federated health research network that aggregates de-identified electronic health records from 108 healthcare organizations. Adult patients undergoing panniculectomy with or without concomitant VHR between 2005 and 2025 were identified. Propensity score matching was applied across 13 demographic and clinical variables to create comparable groups (n=4,306 per cohort). Postoperative outcomes, including debridement, infection, wound dehiscence, and hematoma/seroma, were assessed at 30 days, 90 days, and 12 months. Risk analyses were conducted for each outcome at each timepoint.
RESULTS:
Debridement and infection rates were not significantly different between groups at any timepoint. At 12 months, infection occurred in 11.4% of PAN patients versus 12.3% of PAN+VHR patients (RD -0.91%, p=0.19, RR=0.93). In contrast, wound-related complications were more frequent with PAN+VHR. At 30 days, dehiscence was observed in 3.9% of PAN+VHR patients compared to 2.9% in PAN alone (RD -1.07%, p=0.006, RR=0.73), with differences persisting through 12 months (7.6% vs 5.6%, RD -1.95%, p=0.0003, RR=0.74). Hematoma/seroma rates were not statistically significant at 30 days (2.8% vs. 2.2%, RD -0.58%, p=0.08, RR=0.79), but by 3 months became significantly higher in the PAN+VHR group (4.5% vs. 3.6%, RD -0.91%, p=0.03, RR=0.80) and continued to 12 months (5.5% vs. 4.5%, RD -0.98%, p=0.04, RR=0.82).
CONCLUSION:
In this large national cohort, combining panniculectomy with ventral hernia repair did not increase infection or debridement risk compared to panniculectomy alone. However, PAN+VHR is associated with a higher risk of wound dehiscence throughout all postoperative periods and an increase in hematoma/seroma formation by 3 months. These findings highlight the importance of careful patient selection and counseling when considering a single-stage combined operation. Limitations of retrospective database studies should be considered when interpreting results. Future studies are warranted to refine risk stratification.
Patients with obesity or massive weight loss often present with a symptomatic pannus and may also require abdominal wall reconstruction for concomitant ventral hernias. Previous studies compared panniculectomy with ventral hernia repair (PAN+VHR) to hernia repair alone, often noting higher complication rates. However, the more extensive intervention is typically the panniculectomy (PAN) itself. Direct comparisons between PAN alone and PAN+VHR remain limited, despite the morbidity associated with PAN. We aimed to compare postoperative outcomes of PAN versus PAN+VHR, hypothesizing that adding VHR would not increase complication rates.
METHODS:
We conducted a retrospective cohort study using the TriNetX National Health Research Network. Data were obtained through institutional access to TriNetX, a global federated health research network that aggregates de-identified electronic health records from 108 healthcare organizations. Adult patients undergoing panniculectomy with or without concomitant VHR between 2005 and 2025 were identified. Propensity score matching was applied across 13 demographic and clinical variables to create comparable groups (n=4,306 per cohort). Postoperative outcomes, including debridement, infection, wound dehiscence, and hematoma/seroma, were assessed at 30 days, 90 days, and 12 months. Risk analyses were conducted for each outcome at each timepoint.
RESULTS:
Debridement and infection rates were not significantly different between groups at any timepoint. At 12 months, infection occurred in 11.4% of PAN patients versus 12.3% of PAN+VHR patients (RD -0.91%, p=0.19, RR=0.93). In contrast, wound-related complications were more frequent with PAN+VHR. At 30 days, dehiscence was observed in 3.9% of PAN+VHR patients compared to 2.9% in PAN alone (RD -1.07%, p=0.006, RR=0.73), with differences persisting through 12 months (7.6% vs 5.6%, RD -1.95%, p=0.0003, RR=0.74). Hematoma/seroma rates were not statistically significant at 30 days (2.8% vs. 2.2%, RD -0.58%, p=0.08, RR=0.79), but by 3 months became significantly higher in the PAN+VHR group (4.5% vs. 3.6%, RD -0.91%, p=0.03, RR=0.80) and continued to 12 months (5.5% vs. 4.5%, RD -0.98%, p=0.04, RR=0.82).
CONCLUSION:
In this large national cohort, combining panniculectomy with ventral hernia repair did not increase infection or debridement risk compared to panniculectomy alone. However, PAN+VHR is associated with a higher risk of wound dehiscence throughout all postoperative periods and an increase in hematoma/seroma formation by 3 months. These findings highlight the importance of careful patient selection and counseling when considering a single-stage combined operation. Limitations of retrospective database studies should be considered when interpreting results. Future studies are warranted to refine risk stratification.