Panniculectomy

Panniculectomy

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
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Editor rating	Unrated
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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.

Preoperative management

Patient evaluation

System	Considerations
Airway	Obesity
Neurologic
Cardiovascular
Pulmonary	OSA
Gastrointestinal	H/o bariatric surgery, full stomach
Hematologic
Renal
Endocrine
Other

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.

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

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL	~100cc
Postoperative disposition
Pain management
Potential complications