Abdominal surgery in patients with severe morbid obesity.

At the University of Massachusetts Medical Center, from 1984 to 1992, we performed laparotomy or panniculectomy on 42 individuals weighing from 290 to 600 pounds, each with a height-weight index of over 55. All patients weighted more than 220 percent of ideal body weight. Follow-up ranged 8 to 52 months. All patients underwent panniculectomy except one. Pannus resection was performed by means of a large transverse ellipse. A suprapubic wedge resection often was used to minimize the discrepancy between the lengths of the upper and lower transverse incisions. With severe discrepancy, lateral V-flaps also were utilized to minimize the lateral dog-ear. To facilitate preparation, pannus exsanguination, and surgical resection, 10 to 12 towel clips or 4 to 5 large K-wires or Steinmann pins were passed through the central pannus. These were then suspended by rope from the overhead lighting. A two-team approach appears to have distinct advantages, including minimized blood loss, operative time, pulmonary compromise, and hospital stay. The technical difficulties of manipulating a large pannus were simplified by pannus suspension. Early preoperative involvement of the entire operative team, particularly the plastic surgeon, the anesthesiologist, and the nursing staff, allows for proper evaluation of underlying medical problems and appropriately detailed anesthetic and surgical planning. Surgical management of the abdominal pannus in the morbidity obese patient in this series was performed with apparent clinical efficacy, reasonable safety, and long-term functional improvement.