title: The partial underlay preperitoneal with panniculectomy repair for incisional abdominal hernia in the morbidly obese.
abstract: BACKGROUND
  Because of high frequency, high morbidity, and difficulty of repair, incisional hernias in obese patients represent a particularly vexing and common problem for surgeons. The objective of this study was to describe a highly selective technique for incisional hernia repair with panniculectomy in the morbidly obese. We also describe perioperative characteristics and preliminary outcomes for a limited series of patients who underwent this procedure.
  
  
  METHODS
  We performed a preperitoneal partial mesh underlay with a panniculectomy (PUPP) on 10 patients with incisional hernias and a body mass index (BMI)>40 kg/m(2). The hernia repair was performed by a general surgery team, and the panniculectomy was performed by a plastic surgery team. We retrospectively analyzed perioperative variables for each patient. Phone interviews were conducted to obtain follow-up.
  
  
  RESULTS
  Mean patient age was 53 years (range 32-75 yr) with mean BMI of 46 kg/m(2) (range 41-60 kg/m(2)). Patients had a history of 3.4 average prior abdominal operations, and a median of 3 prior hernia repairs. The average operative time was 371 minutes with a mean estimated blood loss of 162 ccs. Three patients experienced a minor wound complication. There were no major wound complications, and the 30-day mortality rate was zero. At a median and average follow-up time of 805 and 345 days, respectively, one patient developed a hernia recurrence. Patients were satisfied with their appearance and the hernia repair, with mean satisfaction scores of 4.3 and 4.9 out of 5 (very satisfied), respectively.
  
  
  CONCLUSIONS
  The PUPP hernia repair is a viable option for incisional herniorrhaphy and concurrent panniculectomy in the morbidly obese.
authors.affiliation: Division of Gastrointestinal Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Olugbenga.Okusanya@uphs.upenn.edu.
authors.forename: Olugbenga T
authors.initials: OT
authors.lastname: Okusanya
authors.affiliation: Division of Gastrointestinal Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Scott
authors.affiliation: Division of Plastic and Reconstructive Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David W
authors.initials: DW
authors.lastname: Low
authors.affiliation: Division of Gastrointestinal Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D010537:Peritoneum; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Hernia; Incisional; Obesity; Panniculectomy