“Medically Necessary” Panniculectomy to Facilitate Gynecologic Cancer Surgery in Morbidly Obese Patients

A retrospective review of patients in our practice who underwent abdominal panniculectomy to facilitate gynecologic cancer surgerywas performed. The objective of the study was to determine if pannicu-lectomy was a safe and useful procedure in the morbidly obese gyneco-logic cancer patient. A total of 12 patients underwent the procedure between 1992 and 1996. Optimal pelvic oncologic surgery was accom-plished in all 12 patients. All aspects of those procedures were per-formed by gynecologic oncologists. The Buchwalter retractor was usedin all cases. The patients' weights ranged from 170 to 429 pounds, with a mean of 275 pounds. The mean body mass index was 48, with a range from 37 to 67. Four patients had a history of diabetes mellitus. Nine patients healed without wound complications. Three patients developed superficial subcutaneous wound infections/necrosis that were successfully managed with office debridement. Abdominal panniculectomy is a reasonably safe procedure that makes radical pelvic surgery possible regardless of the patient's weight. Prolonged wound bulb suction drainage may decrease the incidence of wound necrosis/infection in these high-risk patients.