Difference between revisions of "Panniculectomy"
(Added additional indications, time frames, positioning details, additional preoperative considerations for this population) |
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=== Indications<!-- List and/or describe the indications for this surgical procedure. --> === | === Indications<!-- List and/or describe the indications for this surgical procedure. --> === | ||
Commonly done after rapid weight loss from (≥ 100lb/45kg) after bariatric surgery. | Commonly done after rapid weight loss from (≥ 100lb/45kg) after bariatric surgery. Can also be done in patient's with excess abdominal tissue leading to SSTI (e.g., necrotizing fasciitis) | ||
=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | === Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | ||
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|- | |- | ||
|Pulmonary | |Pulmonary | ||
|OSA | |OSA, potential with rapid desaturation during hypoventilation with body habitus | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| Line 50: | Line 50: | ||
|- | |- | ||
|Endocrine | |Endocrine | ||
| | |DM often poorly controlled | ||
|- | |- | ||
|Other | |Other | ||
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=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Fat emboli | Fat emboli, DVT, Infection, wound dehiscence | ||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
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|- | |- | ||
|Position | |Position | ||
| | |Supine | ||
| | | | ||
|- | |- | ||
|Surgical time | |Surgical time | ||
| | |1-5hr | ||
| | | | ||
|- | |- | ||
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|- | |- | ||
|Potential complications | |Potential complications | ||
| | |ileus, infection, dehiscence, DVT | ||
| | | | ||
|} | |} | ||
Latest revision as of 16:02, 9 September 2025
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x 1 (18G) |
| Monitors |
Standard, 5-lead EKG |
| Primary anesthetic considerations | |
| Preoperative |
Obesity |
| Intraoperative |
Positioning, fat emboli |
| Postoperative |
Smooth emergence with minimal bucking to minimize tension on suture line |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Panniculectomy is a surgery done to remove stretched out, excess fat and overhanging skin from your abdomen. This can occur after a person undergoes massive weight loss. The skin may hang down and cover your thighs and genitals. Surgery to remove this skin helps improve your health and appearance.
Panniculectomy is different from abdominoplasty. In abdominoplasty, the surgeon will remove extra fat and also tighten your abdominal (belly) muscles. Sometimes, both types of surgery are performed at the same time.
Overview
Indications
Commonly done after rapid weight loss from (≥ 100lb/45kg) after bariatric surgery. Can also be done in patient's with excess abdominal tissue leading to SSTI (e.g., necrotizing fasciitis)
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Obesity |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | OSA, potential with rapid desaturation during hypoventilation with body habitus |
| Gastrointestinal | H/o bariatric surgery, full stomach |
| Hematologic | |
| Renal | |
| Endocrine | DM often poorly controlled |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Standard monitoring
Induction and airway management
Standard induction for healthy patients.
Consider rapid sequence intubation in obese patients, those with GI pathology or repeated abdominal surgeries.
Consider video laryngoscopy.
Positioning
Maintenance and surgical considerations
Standard maintenance.
Take care when calculating drug doses (lean body mass vs actual body mass)
Emergence
Smooth emergence. Avoid bucking to minimize tension on suture lines.
Ensure adequate PONV prophylaxis.
Postoperative management
Disposition
PACU
Pain management
IV narcotics
Potential complications
Fat emboli, DVT, Infection, wound dehiscence
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | Supine | |
| Surgical time | 1-5hr | |
| EBL | ~100cc | |
| Postoperative disposition | ||
| Pain management | ||
| Potential complications | ileus, infection, dehiscence, DVT |
References
Top contributors: Jashvin Patel and Dominic Mangino