Abdominoplasty and panniculectomy in the presence of abdominal wall hernias

The combination of abdominal panniculectomy and hernia repair is becoming an increasingly accepted technique. Panniculectomy can be performed immediately in conjunction with hernia repair or on a delayed basis. Advantages of immediate panniculectomy include reduced infection, better healing, and improved patient satisfaction. Disadvantages include added length of the operation, compromised vascularity of the abdominal skin and fat, and the potential for delayed healing. There is a variety of approaches to performing a panniculectomy. These include a standard transverse panniculectomy, fleur-de-lis incision, and a Mercedes incision. A significant advancement in support of immediate panniculectomy is the concept of perforator sparing that can preserve the vascularity to the surrounding adipocutaneous tissues and facilitate body contouring and minimize morbidities related to delayed healing. Panniculectomy should be considered in patients with an abdominal hernia and pannus.