Panniculectomy with Concurrent Incarcerated Incisional Hernia Repair: A Case Report
Abstract
Significant weight loss after bariatric surgery often results in excess skin and subcutaneous tissue, leading to the formation of a pannus. This excess tissue pulls the abdomen downward, sometimes necessitating a panniculectomy. Additionally, the incidence of incisional hernia after a cesarean section is relatively low, ranging from 0.0% to 5.6%, with risk factors including obesity, smoking, diabetes, history of multiple C-sections, and the type of incision. We present a case of a patient who underwent an elective panniculectomy with concurrent incisional hernia repair, in which an incarcerated hernia was found within the pannus. Our patient presented with a grade 3 pannus covering her mid-thigh with a history of multiple cesarean sections, gastric bypass surgery, morbid obesity, diabetes mellitus and hyperlipidemia. She sought consultation for panniculectomy due to impaired daily function and had no signs of strangulation, nausea, vomiting, or bowel obstruction. After discussing treatment options, she opted for surgery. In the operating room, a transverse elliptical incision was made, and the skin and subcutaneous tissue were elevated off the underlying fascia and a fascial defect measuring 3 x 4cm, containing herniated omentum and small bowel, was noted. No evidence of strangulation or bowel compromise was found. A primary repair was performed using interrupted non-absorbable running sutures in a figure-of-eight technique, reinforced with a continuous suture. The excess pannus was excised en bloc, bilateral drains were placed, and the wound was closed in layers with an abdominal binder applied postoperatively. This case highlights an atypical presentation of an incisional hernia incarcerated within a pannus, emphasizing the importance of thorough preoperative evaluation and intraoperative vigilance in post-bariatric patients and those with multiple prior abdominal surgeries. To our knowledge, a case of an incarcerated hernia within a pannus has not been previously reported.
Start Time
16-4-2025 1:30 PM
End Time
16-4-2025 4:00 PM
Presentation Type
Poster
Presentation Category
Health
Student Type
Clinical Doctoral Student (e.g., medical student, pharmacy student)
Faculty Mentor
Jeremy Powers
Faculty Department
Department of Plastic and Reconstructive Surgery
Panniculectomy with Concurrent Incarcerated Incisional Hernia Repair: A Case Report
Significant weight loss after bariatric surgery often results in excess skin and subcutaneous tissue, leading to the formation of a pannus. This excess tissue pulls the abdomen downward, sometimes necessitating a panniculectomy. Additionally, the incidence of incisional hernia after a cesarean section is relatively low, ranging from 0.0% to 5.6%, with risk factors including obesity, smoking, diabetes, history of multiple C-sections, and the type of incision. We present a case of a patient who underwent an elective panniculectomy with concurrent incisional hernia repair, in which an incarcerated hernia was found within the pannus. Our patient presented with a grade 3 pannus covering her mid-thigh with a history of multiple cesarean sections, gastric bypass surgery, morbid obesity, diabetes mellitus and hyperlipidemia. She sought consultation for panniculectomy due to impaired daily function and had no signs of strangulation, nausea, vomiting, or bowel obstruction. After discussing treatment options, she opted for surgery. In the operating room, a transverse elliptical incision was made, and the skin and subcutaneous tissue were elevated off the underlying fascia and a fascial defect measuring 3 x 4cm, containing herniated omentum and small bowel, was noted. No evidence of strangulation or bowel compromise was found. A primary repair was performed using interrupted non-absorbable running sutures in a figure-of-eight technique, reinforced with a continuous suture. The excess pannus was excised en bloc, bilateral drains were placed, and the wound was closed in layers with an abdominal binder applied postoperatively. This case highlights an atypical presentation of an incisional hernia incarcerated within a pannus, emphasizing the importance of thorough preoperative evaluation and intraoperative vigilance in post-bariatric patients and those with multiple prior abdominal surgeries. To our knowledge, a case of an incarcerated hernia within a pannus has not been previously reported.