Panniculectomy at Time of Cesarean Section Is Feasible

WASHINGTON – Modified panniculectomy at the time of cesarean section may be a useful adjunct for decreasing postoperative morbidity in morbidly obese patients, based on results of a small case series.

"We found that women who underwent panniculectomy at the time of cesarean section were less likely to have significant wound complications than controls that did not undergo panniculectomy," Dr. Pedro Miranda-Seijo said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

He and his coinvestigators conducted a chart review during 2004 that included 30 morbidly obese patients who underwent incidental panniculectomy during cesarean section and a control group of 29 morbidly obese women who underwent a cesarean section without a panniculectomy. The definition of morbidly obese was a body mass index (BMI) of greater than 42 kg/m².

"The decision to perform a panniculectomy was made originally by me before starting surgery, at which time I would obtain informed consent," Dr. Miranda-Seijo said in an interview.

"After I’d done the first 10 or 15 cases, the residents and other attending began trying to schedule elective cases on morbidly obese patients on days that I would be available; often I would see these patients during their antepartum visit and discuss the procedure with them," said Dr. Miranda-Seijo, who is an obstetrician at Denver Health and Hospitals. "I am the only attending that does these procedures; [patients] understand that if they come in labor and I’m not available, they would not be getting a panniculectomy."

Also "when a morbidly obese patient who is in labor needs a cesarean section, if I’m available, I often get called to do it," he said. "If the indication is urgent but not emergent – say failure to descend or secondary arrest of dilation – and I will be available in a few hours, the case is often held for me to do when I arrive," he said.

Notably, the women in this series who underwent panniculectomy had significantly greater BMIs – a mean of 54 vs. 49 kg/m² for the control group.

Of the 30 women who underwent modified panniculectomy at the time of cesarean section, there was one operative site infection that required readmission. In contrast, in the control group there were seven late wound complications and three readmissions. The difference in late wound complications was significant.

There was a nonsignificant difference in operative time, with a mean of 66 minutes with a panniculectomy compared with 63 minutes for cesarean section alone. Panniculectomy did not significantly increase blood loss.

"The extra time needed to infiltrate the skin, remove the pannus, and [close] the large incision is offset by the greater speed achieved in accessing the uterus, delivering the baby, and closing the uterus and fascia, due to better exposure and easier access," Dr. Miranda-Seijo noted.

Several questions were raised by the study: Does the removal of so much adipose tissue have an effect on glucose tolerance, and could this procedure be used by patients as a starting point to initiate healthier lifestyle changes? Additional research will be needed to provide answers, he said.

Dr. Miranda-Seijo reported that he had no relevant financial disclosures.

WASHINGTON – Modified panniculectomy at the time of cesarean section may be a useful adjunct for decreasing postoperative morbidity in morbidly obese patients, based on results of a small case series.

"We found that women who underwent panniculectomy at the time of cesarean section were less likely to have significant wound complications than controls that did not undergo panniculectomy," Dr. Pedro Miranda-Seijo said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

He and his coinvestigators conducted a chart review during 2004 that included 30 morbidly obese patients who underwent incidental panniculectomy during cesarean section and a control group of 29 morbidly obese women who underwent a cesarean section without a panniculectomy. The definition of morbidly obese was a body mass index (BMI) of greater than 42 kg/m².

"The decision to perform a panniculectomy was made originally by me before starting surgery, at which time I would obtain informed consent," Dr. Miranda-Seijo said in an interview.

"After I’d done the first 10 or 15 cases, the residents and other attending began trying to schedule elective cases on morbidly obese patients on days that I would be available; often I would see these patients during their antepartum visit and discuss the procedure with them," said Dr. Miranda-Seijo, who is an obstetrician at Denver Health and Hospitals. "I am the only attending that does these procedures; [patients] understand that if they come in labor and I’m not available, they would not be getting a panniculectomy."

Also "when a morbidly obese patient who is in labor needs a cesarean section, if I’m available, I often get called to do it," he said. "If the indication is urgent but not emergent – say failure to descend or secondary arrest of dilation – and I will be available in a few hours, the case is often held for me to do when I arrive," he said.

Notably, the women in this series who underwent panniculectomy had significantly greater BMIs – a mean of 54 vs. 49 kg/m² for the control group.

Of the 30 women who underwent modified panniculectomy at the time of cesarean section, there was one operative site infection that required readmission. In contrast, in the control group there were seven late wound complications and three readmissions. The difference in late wound complications was significant.

There was a nonsignificant difference in operative time, with a mean of 66 minutes with a panniculectomy compared with 63 minutes for cesarean section alone. Panniculectomy did not significantly increase blood loss.

"The extra time needed to infiltrate the skin, remove the pannus, and [close] the large incision is offset by the greater speed achieved in accessing the uterus, delivering the baby, and closing the uterus and fascia, due to better exposure and easier access," Dr. Miranda-Seijo noted.

Several questions were raised by the study: Does the removal of so much adipose tissue have an effect on glucose tolerance, and could this procedure be used by patients as a starting point to initiate healthier lifestyle changes? Additional research will be needed to provide answers, he said.

Dr. Miranda-Seijo reported that he had no relevant financial disclosures.

WASHINGTON – Modified panniculectomy at the time of cesarean section may be a useful adjunct for decreasing postoperative morbidity in morbidly obese patients, based on results of a small case series.

"We found that women who underwent panniculectomy at the time of cesarean section were less likely to have significant wound complications than controls that did not undergo panniculectomy," Dr. Pedro Miranda-Seijo said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

He and his coinvestigators conducted a chart review during 2004 that included 30 morbidly obese patients who underwent incidental panniculectomy during cesarean section and a control group of 29 morbidly obese women who underwent a cesarean section without a panniculectomy. The definition of morbidly obese was a body mass index (BMI) of greater than 42 kg/m².

"The decision to perform a panniculectomy was made originally by me before starting surgery, at which time I would obtain informed consent," Dr. Miranda-Seijo said in an interview.

"After I’d done the first 10 or 15 cases, the residents and other attending began trying to schedule elective cases on morbidly obese patients on days that I would be available; often I would see these patients during their antepartum visit and discuss the procedure with them," said Dr. Miranda-Seijo, who is an obstetrician at Denver Health and Hospitals. "I am the only attending that does these procedures; [patients] understand that if they come in labor and I’m not available, they would not be getting a panniculectomy."

Also "when a morbidly obese patient who is in labor needs a cesarean section, if I’m available, I often get called to do it," he said. "If the indication is urgent but not emergent – say failure to descend or secondary arrest of dilation – and I will be available in a few hours, the case is often held for me to do when I arrive," he said.

Notably, the women in this series who underwent panniculectomy had significantly greater BMIs – a mean of 54 vs. 49 kg/m² for the control group.

Of the 30 women who underwent modified panniculectomy at the time of cesarean section, there was one operative site infection that required readmission. In contrast, in the control group there were seven late wound complications and three readmissions. The difference in late wound complications was significant.

There was a nonsignificant difference in operative time, with a mean of 66 minutes with a panniculectomy compared with 63 minutes for cesarean section alone. Panniculectomy did not significantly increase blood loss.

"The extra time needed to infiltrate the skin, remove the pannus, and [close] the large incision is offset by the greater speed achieved in accessing the uterus, delivering the baby, and closing the uterus and fascia, due to better exposure and easier access," Dr. Miranda-Seijo noted.

Several questions were raised by the study: Does the removal of so much adipose tissue have an effect on glucose tolerance, and could this procedure be used by patients as a starting point to initiate healthier lifestyle changes? Additional research will be needed to provide answers, he said.

Dr. Miranda-Seijo reported that he had no relevant financial disclosures.