PANNICULECTOMY AND SUPRAUMBILICAL VERTICAL MIDLINE INCISIONS IN MORBIDLY OBESE GYNECOLOGIC ONCOLOGY PATIENTS

Background: We reviewed the outcomes of panniculectomy and supraumbili cal vertical midline incisions in morbidly obese women undergoing: gyn ecologic operations. Study Design: Medical records were reviewed for 6 2 morbidly obese women with a large dependent pannus who underwent gyn ecologic operations on the Gynecologic Oncology Service at the State U niversity of New York at Stony Brook between May 1990 and July 1997. T hirty-five patients underwent panniculectomy and 27 had a supraumbilic al vertical midline incision, forming the study groups. The patient ch arts were abstracted for demographic, perioperative, and postoperative data. Results: For the entire study population, the average age was 5 6 years, the mean body mass was 128.6 kg, and the mean Quetelet Index was 48.3 kg/m(2). The mean operative time and estimated blood loss wer e similar for both groups. Eight percent of the patients had urologic injuries, evenly distributed between the groups. Postoperative infecti ons, wound breakdowns, and hospital stay were greater for the pannicul ectomy group than for the supraumbilical vertical midline incision gro up (p < 0.05). Uniform use of subcutaneous closed-suction drains (sinc e 1995) was associated with a significant reduction in the incidence o f wound breakdowns and a shorter hospital stay in the panniculectomy g roup. Conclusions: Panniculectomy and supraumbilical vertical midline incision provide reasonable peritoneal access with acceptable rates of postoperative complications for morbidly obese women undergoing gynec ologic operations. (C) 1998 by the American College of Surgeons.