This list is by no means comprehensive but highlights areas of focus in specific regard to the panniculectomy patient that have evolved in the senior author’s practice over time based on experience and evidence-based literature review. What follows are practical pearls that the senior author uses to improve operative outcomes for panniculectomy in the preoperative, intraoperative, and postoperative setting. 4 Adherence to the basic surgical and medical principles presented in this article can improve the quality of experience for both patient and surgeon alike. 3 While the patient is very likely to see benefit from panniculectomy, and receive high satisfaction, there is an effect from even the smallest complications on patient outcome, satisfaction of both the patient and surgeon, and health care burden. However, due to the patient population requesting panniculectomy, and the demands placed on the tissues, there is a high rate of complications and an even a higher rate of suboptimal outcomes, which in turn demands greater attention to perioperative planning and execution than standard. The panniculectomy is a theoretically simple procedure that can be performed expeditiously and adequately with standard planning, and therefore, it is often marginalized in its nuances. The panniculectomy procedure is performed with the intention of surgically removing this excess skin and subcutaneous tissue to improve the patient’s function and to decrease morbid sequelae such as those mentioned previously. This apron of tissue, the panniculus, is frequently on the lower abdomen but can include the mons pubis, upper abdomen, flanks, and back. In addition, even for those who have not undergone a bariatric surgery, there are functional impairments that can result from excessive skin and subcutaneous tissue, including ulcerations and nonhealing wounds, hygiene issues, rashes, inability to perform activities of daily living, and joint issues, among others. 2 While bariatric surgery is successful in treating obesity and metabolic dysfunction, patients are often left to deal with the excess abdominal skin and subcutaneous tissue left behind after weight loss. 1 To parallel this trend, there has been a concomitant increase in the incidence of bariatric surgeries performed in the United States, with over 200,000 being performed each year. According to the Centers for Disease Control, the prevalence of obesity in the United States is approaching 40%, with an associated cost of $147 billion per annum. The incidence of obesity has been steadily increasing over the past decade, with a significant burden to both patients and the healthcare system as a whole.
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