Outcomes after Ventral Hernia Repair with Concurrent Panniculectomy: A Large Database Review.

Background: Patients with large pannus and ventral hernias may benefit from undergoing panniculectomy performed concurrently with open ventral hernia repair (VHR-PAN). However, there has been concerns related to increase surgical site occurrences when adding a panniculectomy. This study aims to evaluate outcomes of open VHR with and without panniculectomy using a large hernia specific database.

Study Design: The Abdominal Core Health Quality Collective (ACHQC) database was queried from 2012 to 2023 for patients who underwent VHR-only vs VHR-PAN. Patient and surgical characteristics were described and compared. Short-term outcomes including surgical site infection (SSI), surgical site occurrence (SSO), and SSO requiring procedural intervention (SSOPI) were compared. Patient reported outcomes (PROs) and hernia recurrence were compared at 1 year. Logistic regression was used to identify risks associated with the above outcomes.

Results: There were 28,140 patients who underwent open VHR, 2108 where panniculectomy data were included (yes or no), and 870 who underwent VHR-PAN. Patients who underwent VHR-PAN were more likely to be female,78.3% vs 64.8% (p < 0.0001), have a BMI over 40, 21.0% vs 7.8% (p < 0.0001) with greater median hernia width, 10.0 [7.0, 15.0] vs 8.0 [3.0, 13.0] (p < 0.0001). In a matched analysis, there was no significant difference in SSI, SSO, SSOPI, or 1 year hernia recurrences rates in the VHR-PAN group (p<0.05).

Conclusion: This study demonstrated that VHR with concurrent panniculectomy is not significantly associated with an increased risk of complications. Concurrent panniculectomy can be considered for selected patients needing VHR.