Fleur-de-lis Panniculectomy after Bariatric Surgery: Our experience
Genevieve B. Broderick, MD, Richard Montilla, MD, John Castle, MD, Mustafa Akyurek, MD, Janice F. Lalikos, MD.
University of Massachusetts Medical School, Worcester, MA, USA.
Background: With increasing numbers of patients undergoing bariatric surgery, plastic surgeons are faced with growing numbers of patients who need body-contouring procedures. Panniculectomy is one of the most commonly performed procedures, and is known to be fraught with complications such as seroma and hematoma due to the large incisions and potential for dead-space. For this reason, many surgeons avoid the fleur-de-lis (or “inverted-T”) panniculectomy despite the possibility to resect redundant tissue in both the vertical and horizontal direction. Our institution has transitioned almost exclusively to this type of panniculectomy and this study reviews our experience over the past two years.
Methods: This is a retrospective chart review of 130 consecutive post-bariatric panniculectomies performed over the past two years by six surgeons at our institution.
Results: Ninety percent of the patients were female. Mean age of the population was 44 (range 25-60). Mean weight loss prior to panniculectomy was 128 pounds and mean BMI at time of surgery was 30 (range 21-51). Forty-nine patients had additional procedures performed at the time of panniculectomy including most commonly hernia repair, mastopexy, and brachioplasty. Mean weight of resected pannus tissue was 2.9 kg. Hospital stay averaged less than 2 days and follow up was greater than 4 months.
Thirty patients (20%) underwent traditional transverse panniculectomy and one-hundred patients (80%) had fleur-de-lis incision. Twenty-three patients (18%) had post-operative complications. Ten had seroma, nine had hematoma, three had cellulitis, and one each had abscess, partial umbilical necrosis, and mild incisional dehiscence. Five patients with complications were in the transverse group (17%) and eighteen were in the fleur-de-lis group (18%). There was no significant difference between the complication rates (p = 1.0).
Conclusions: Surgeons often hesitate to perform fleur-de-lis panniculectomy after bariatric surgery due to fear of increased rate of complication in a procedure already fraught with complications. Our results suggest that fleur-de-lis panniculectomy is not associated with an increased rate of complication when compared to the traditional transverse incision. In addition, the fleur-de-lis incision provides the ability to create a better functional and cosmetic outcome by resecting redundant skin in both the vertical and horizontal direction. The surgeons at our institution are in agreement that minimal undermining during a panniculectomy will curtail complications with any given technique.