Comparative Effectiveness Analysis of Ventral Hernia Repair and Transverse Abdominis Release With and Without Panniculectomy: A 4-Year Match-Paired Analysis
Chris Amro*, Charlie Messa IV, Ellen F. Niu, J. Reed McGraw, Stephanie E. Honig, Harrison Davis, Robyn B. Broach, John P. Fischer
University of Pennsylvania, Philadelphia, PA
As the prevalence of obesity continues to rise, the number of concurrent ventral hernia repair (VHR) and panniculectomy procedures also rises. However, data regarding long-term outcomes following concurrent transverse abdominis release (TAR) and panniculectomy is limited. This study aims to compare long-term clinical outcomes and quality of life (QoL) following TAR with and without concurrent panniculectomy.
A single-center, retrospective review from 2016-2022 was performed examining subjects who underwent VHR with TAR and panniculectomy. A propensity-scored matching was performed based on age, BMI, ASA, and ventral hernia working group (VHWG). Patients with parastomal hernias were excluded. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and QoL were analyzed.
A total of fifty subjects (25 per group) were identified (median follow-up, 48.8 months). Median age and BMI were 57 years (47-64 years) and 31.8kg/m2 (28-36kg/m2), respectively. The average hernia defect size was 354.5cm2±188.5cm2. Patients who underwent VHR with TAR and panniculectomy were majority female (64% vs. 12%, p<0.05). There was no difference between the groups regarding hernia recurrence, emergency department visits, readmissions or reoperations (p>0.05). However, patients who underwent VHR with TAR and panniculectomy demonstrated a significant increase in delayed healing (44% vs. 4%, p<0.05) and seromas (24% vs. 4%, p<0.05). QoL analysis identified a significant improvement in postoperative QoL (p<0.005) for both groups across all domains, that continued throughout the 4-year follow-up period. Patients who underwent TAR with panniculectomy had a greater percentage change in overall QoL scores (53.8% vs 32.4%;p <0.05) and appearance scores.
VHR with TAR and panniculectomy can be performed safely with low recurrence and complication rates at long-term follow-up. Despite increased postoperative complications, patients have significant improvement in disease specific QoL and even higher scores in the appearance domain.
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