Cooper Joshua M, Paige Keith T, Beshlian Kevin M, Downey Daniel L, Thirlby Richard C
Department of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.
Ann Plast Surg. 2008 Aug;61(2):188-96. doi: 10.1097/SAP.0b013e318158a7b2.
We reviewed our experience with 3 operative techniques for abdominal panniculectomies to determine differences in complication rates and levels of patient satisfaction.
This retrospective study included 92 consecutive patients who underwent abdominal panniculectomies over a 9-year period. Patients underwent one of 3 panniculectomy techniques: fleur-de-lis (n = 25), transverse incisions with minimal undermining (n = 30), or transverse incisions with extensive undermining (n = 37). Postoperatively, patient satisfaction surveys were completed.
Median pannus weight was 4.4 kg (range, 1.6-20.5). Sixty-eight patients (73.9%) had a previous gastric bypass. Median body mass index (BMI) was 38 kg/m2 (range, 22-66.9). Median follow-up for complications was 8.1 week (range, 1-235). Forty of 92 patients (43%) suffered wound complications. The reoperation rate was 13%. Postoperative complication rates were higher among hypertensive patients (61% vs. 36%; P = 0.04). There was a trend towards increased complications among those with higher BMI and pannus weights. There was not a significant relationship between operative technique and overall complication rate. Mean length of follow-up for patient questionnaire completion was 2 years, 11 months (range, 1-9 years). Eighty-one percent of those responding to the mailed questionnaire were satisfied with their operative results. There were no statistically significant differences between the technique used and patient satisfaction level. Concomitant hernia repair was performed in 47% of patients without increased wound complications.
Patients were satisfied with the results of their panniculectomy, although complications were common. Higher BMI, larger pannus size, and hypertension were correlated with increased complication rates. The minimal undermining, extensive undermining, and the fleur-de-lis panniculectomy techniques result in similar patient satisfaction rates and complication rates.
我们回顾了采用3种手术技术进行腹壁皮肤脂肪切除术的经验，以确定并发症发生率和患者满意度水平的差异。
这项回顾性研究纳入了9年间连续接受腹壁皮肤脂肪切除术的92例患者。患者接受了3种腹壁皮肤脂肪切除技术之一：百合花形切口（n = 25）、有限潜行分离的横向切口（n = 30）或广泛潜行分离的横向切口（n = 37）。术后完成患者满意度调查。
腹壁赘肉的中位数重量为4.4 kg（范围1.6 - 20.5 kg）。68例患者（73.9%）曾接受过胃旁路手术。体重指数（BMI）中位数为38 kg/m²（范围22 - 66.9）。并发症的中位随访时间为8.1周（范围1 - 235周）。92例患者中有40例（43%）出现伤口并发症。再次手术率为13%。高血压患者的术后并发症发生率更高（61%对36%；P = 0.04）。BMI和腹壁赘肉重量较高者的并发症有增加趋势。手术技术与总体并发症发生率之间无显著关系。完成患者问卷调查的平均随访时间为2年11个月（范围1 - 9年）。回复邮寄问卷的患者中有81%对手术结果满意。所用技术与患者满意度水平之间无统计学显著差异。47%的患者同时进行了疝修补，且伤口并发症未增加。
尽管并发症很常见，但患者对腹壁皮肤脂肪切除术的结果感到满意。较高的BMI、更大的腹壁赘肉尺寸和高血压与并发症发生率增加相关。有限潜行分离、广泛潜行分离和百合花形腹壁皮肤脂肪切除技术导致相似的患者满意度和并发症发生率。
