BACKGROUND: Ventral hernia repair (VHR) is often performed in patients with obesity. While panniculectomy improves cosmetic outcomes, it may increase complications, particularly wound-related adverse events. Despite its widespread use, the impact of concurrent panniculectomy on postoperative complications in VHR remains unclear. This study aimed to assess whether concurrent panniculectomy increases postoperative complications in VHR.
METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane databases for studies published up to April 2024 comparing surgical outcomes in patients undergoing VHR with and without concurrent panniculectomy. We assessed recurrence, seroma, hematoma, surgical site infections (SSI), wound dehiscence, skin necrosis, chronic wound, length of stay (LOS), readmissions, duration of surgery, and deep venous thromboembolism (DVT). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled for dichotomous and continuous endpoints, respectively. We used RStudio for statistics and heterogeneity was assessed with I2 statistics.
RESULTS: We screened 890 studies, fully reviewed 40, and included 11 observational studies and 2 randomized controlled trials, comprising 23,354 patients. Of these, 2,972 (13%) patients underwent VHR with concurrent panniculectomy (VHR-PAN). The mean age ranged from 37 to 59 years, and 73% of the sample were women. The mean BMI varied from 29 to 45 kg/m2, and 75% of the patients underwent mesh repair. The mean defect area ranged from 36 to 389 cm2. Most repairs were performed using mesh (75%) in an underlay position (68%) and 24% underwent component separation. VHR-PAN was associated with a decrease in recurrence rates (RR 0.74; 95% CI 0.62 to 0.89; p < 0.001; I2 = 1%) with a follow-up ranging from 1 to 36 months. Furthermore, subgroup analysis of recurrence in studies with a mean follow-up of at least one year also showed a reduction in recurrence (RR 0.72; 95% CI 0.60 to 0.88; p < 0.001; I2 = 12%), with a follow-up ranging from 12 to 36 months. Moreover, concurrent panniculectomy was associated with increased SSI (RR 1.31; 95% CI 1.13 to 1.51; p < 0.001; I2 = 0%), SSO (RR 1.49; 95% CI 1.26 to 1.77; p < 0.001; I2 = 11%), skin necrosis (RR 2.94; 95% CI 1.26 to 6.85; p = 0.012; I2 = 0%) and reoperation (RR 1.73; 95% CI 1.32 to 2.28; p < 0.001; I2 = 0%), and longer LOS (MD 0.90 day; 95%CI 0.40 to 1.40; p < 0.001; I2 = 56%). There was no significant difference in ocurrence of DVT, enterocutaneous fistula, hematoma, seroma, or wound dehiscence, neither on operative time or readmission rates.
CONCLUSIONS: VHR-PAN is associated with lower recurrence rates. However, it increases the risk of wound morbidity and reoperation and prolongs hospital stay. Surgeons should carefully weigh the risks and benefits of performing VHR-PAN.
BACKGROUND: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024542721).

Introduction: Diastasis recti (DR) is characterized by an abnormal separation between the rectus abdominis muscles. Traditional repair includes only plication; however, complications may arise in the presence of concurrent ventral hernias (VH). This study aims to evaluate the safety and feasibility of diastasis repair in a United Arab Emirates (UAE) population. Methods and Procedures: This retrospective cohort study was conducted with IRB approval. All patients who underwent a DR repair (DRR) with concomitant ventral hernia repair between October 2022 and February 2024 were included. Results: A total of 20 patients were included in the study. The cohort was 80% female, with a mean overall age of 44.05 years. The mean body mass index was 27.4 kg/m2. All patients (100%) presented with DR associated with an abdominal wall defect; 17 patients (85%) with umbilical hernia, 2 patients (10%) with umbilical and incisional hernia, and 1 patient (5%) with umbilical with epigastric hernia. A total of 12 (60%) patients underwent laparoscopic DRR concomitant with VH repair, 5 (25%) patients underwent open DRR with VH repair and abdominoplasty, and 1 patient (5%) underwent DRR with VH repair and liposuction. All cases were successful without complications or conversions. Complications within 30 days included only seromas in 6 patients (30%), one requiring drainage. Conclusion: Our initial experience suggests that DR repair with concomitant VH repair and/or abdominoplasty is feasible and safe in the UAE population. Our experience demonstrated surgical outcomes compared to other regions in the world.

BACKGROUND: Often secondary to obesity, adult-acquired buried penis (AABP) is an increasingly common condition. AABP is often detrimental to urinary and sexual function, psychological well-being, and quality of life. Surgical treatment involves resection of excess soft tissue, with adjunct procedures, including a panniculectomy. However, few studies have been conducted investigating the risks of panniculectomy in the context of AABP surgical repair.
METHODS: A systematic review of PubMed, Embase, and Cochrane databases was performed, following the PRISMA 2020 guidelines. Descriptive statistics regarding patient demographics, complications, and surgical technique were conducted. After this, an analysis of AABP patients within the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was conducted.
RESULTS: Four studies including 57 patients reported panniculectomy as part of buried penis repair (PBPR). Surgical approaches included a modified trapezoid and traditional transverse incision. All authors utilized postoperative drains. Dehiscence and wound infection were the most frequent complications. Univariate NSQIP analysis revealed that PBPR patients had higher body mass index, more comorbidities, and greater wound complication rates. Multivariate analysis revealed that PBPR did not significantly increase 30-day complications compared to isolated BPR ( P > 0.05), while body mass index remained a significant predictor.
CONCLUSIONS: Surgical repair of AABP can greatly improve patient quality of life. The available literature and NSQIP-based analysis reveal that concurrent panniculectomy in AABP repair has a comparable complication profile. Future studies are necessary to better characterize the long-term outcomes of this PBPR.

The procedure with the highest rate of opioid prescription in plastic surgery is abdominoplasty. Additionally, plastic surgery patients are at a particularly elevated risk of becoming opioid-dependent. The main objective of this study was to perform a systematic review and create an algorithm for a multimodal pain regimen specific to patients undergoing abdominoplasty. A systematic search of the research literature was performed to summarize the prevailing understanding of multimodal pain control in the management of abdominoplasty. The initial search yielded 448 articles. Sixty-eight manuscripts were identified for full-text review. The effectiveness of current strategies was evaluated by way of pain scores, opioid usage, and length of stay, as well as other measures of physical function such as time to early mobilization. In 32 studies involving 2451 patients, the efficacy of different pain regimens during abdominoplasty was evaluated. Among nontraditional, opioid-sparing analgesia, efficacy of treatment interventions for improved pain and decreased opioid usage was found inall studies. Among local infusion studies, efficacy of treatment interventions for improved pain and decreased opioid usage was found in 78% of studies. Last, among regional block studies, efficacy of treatment interventions for improved pain was found in 87%, with 73% efficacy for decreased opioid usage. Multimodal pain regimens in abdominoplasty have the potential to play an important role in opioid-sparing practices in medicine by incorporating nonopioid pain adjuvants such as nonsteroidal anti-inflammatory drugs and transversus abdominis plane blocks in the preoperative, perioperative, and postoperative periods.
METHODS:

BACKGROUND: Drains are traditionally inserted during surgery for reduction of fluid accumulation in the post-operative period. The appearance of drained fluids and their quantity can be early predictors of complications. Over the years, several studies have been conducted in attempt to determine the optimal number of drains that result in low rates of fluid accumulation with minimal impairment of quality of life.
OBJECTIVE: Determine the optimal number of suction drains in abdominoplasty procedures.
METHODS: Retrospective cohort study, analyzing all abdominoplasty patients operated by a single surgeon. Patients were stratified into 3 groups based on number of drains inserted at the end of the procedure. Rate of complications was compared between the groups and a multivariate logistic regression model was computed for the development of complications.
RESULTS: Seven-hundred and forty three patients were included in the analysis of this study. No drains were inserted in 355 patients (45%), whereas a single drain was inserted in 153 (20.6%) 2 drains in 255 patients (34.4%). Patients for whom a single drain was inserted intra-operatively, experienced at a statistically significant lower rate, surgical site infections (OR = 0.235), hypertrophic scars (OR = 0.326), wound dehiscence (OR = 0.272), as compared to patients with no drains. On the contrary, insertion of single drain was associated with a statistically significant higher risk for development of seroma (OR = 6.276) and the need for revision surgery (OR = 2.452).
CONCLUSIONS: Insertion of a single drain is associated with a lower risk of SSI and wound- dehiscence, but a greater risk for seroma development that requires surgical intervention.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BACKGROUND: Abdominoplasty is a critical aesthetic and functional procedure for individuals who have undergone massive weight loss. Numerous techniques have been proposed to optimize aesthetic results while minimizing complications.
METHODS: This prospective study examined 500 patients who underwent abdominoplasty during body-contouring procedures between 1 January 2018 and 31 December 2021 at a tertiary center. The Skin-Adipose Tissue-Muscle (SAM) protocol was employed to analyze the operative strategies and complication rates and compare them with the existing literature. Furthermore, patient satisfaction and aesthetic outcomes were measured one year post-operation using a comprehensive four-point questionnaire evaluated by the patients themselves and two independent surgeons.
RESULTS: Participants had an average age of 34.8 years and a mean BMI of 31.1 kg/m2. The surgeries included 328 full abdominoplasties and 172 T-inverted abdominoplasties. Notable complications included wound infection (4%), wound dehiscence (8.6%), tissue necrosis (0.6%), seroma (8.4%), and hematoma (2.6%). A higher BMI was correlated with an increased risk of complications and lower patient satisfaction. Data analysis was performed using Stata version 18 software.
CONCLUSIONS: The increasing prevalence of obesity highlights an urgent need for more bariatric surgeries and subsequent abdominoplasties to mitigate the effects of massive weight loss. A crucial link between elevated BMI and a heightened risk of postoperative complications, emphasizing the necessity for standardized surgical protocols tailored to individuals with higher BMI, was noted. Innovatively, future studies must further investigate the intricate dynamics between BMI and surgical risks. Exploring and establishing uniform, adaptive surgical guidelines promise to revolutionize patient care by significantly reducing complications and enhancing recovery and satisfaction following abdominoplasty.

UNASSIGNED: Abdominoplasty is a common surgical procedure in which excess abdominal skin and fat are reduced to improve body contouring. Fibrin sealant has been proposed to reduce postsurgical bleeding and exudation. In this study, we evaluated whether there was a significant statistical difference in surgical output between the use of fibrin glue and its nonuse in abdominoplasty surgery, specifically in reducing bleeding and exudation.
UNASSIGNED: A retrospective chart review of 68 postbariatric abdominoplasty patients (58 females, 10 males) was performed. We divided the patients into Group A (30 cases, 44%), in which we used fibrin sealant, and Group B (38 cases, 56%), in which we did not use fibrin glue. We calculated the total amount of liquid in suction drainages until the day of their removal. Statistical analysis included the independent t-test with a significance level of 0.05.
UNASSIGNED: The average drainage output in Group A was 620.0 ± 375.0 mL, whereas in Group B, it was 500.0 ± 290.0 mL. Results indicate an insignificant correlation between the use of fibrin glue and the amount of liquid in the surgical drains (t = 1.52, p = 0.13). The result is not significant at p <.05 according to the independent t-test.
UNASSIGNED: The use of fibrin sealant surely has a high value in all surgical branches to reduce postoperative complications, but in our study, we did not find any advantages in its use for reducing surgical drain output in abdominoplasty patients.

暂无摘要。

BACKGROUND: Diastasis recti abdominis (DRA) indicates an abnormal separation of the rectus abdominal muscles from the midline, resulting in abdominal bulging. Recent literature shows a correlation between DRA and back pain, stress urinary incontinence. Primary goal of this study is to check the correlation between DRA correction in abdominoplasty and improvement of urinary symptoms.
METHODS: This is a prospective study on patients with post-pregnancy rectus diastasis who underwent surgical correction of diastasis through conventional abdominoplasty. All patients were asked to complete the ICIQ-FLUTS questionnaire, which assesses urinary disorders, and the SF-36 questionnaire, aimed at quantifying health-related quality of life. The questionnaires were administered to patients the day before surgery and one year after surgery.
RESULTS: The recruited patients (n = 51) were then stratified on the presence or absence of stress urinary incontinence. Of the 39 patients with preoperative incontinence, the average scores of the ICIQ-FLUTS were analyzed. In particular, for the questions relating to stress urinary incontinence a statistically significant difference was reported between the preoperative mean and the 1-year mean for all questions (p value<0.05). As regards quality of life, comparing the average scores of each question of SF-36 there is an improvement in the values of all the variables of the questionnaire.
CONCLUSIONS: The strength of this study, which distinguishes it from other literature, is that the changes in abdominal pressure post-abdominoplasty which should lead to a worsening of stress incontinence, do not cause it. On the contrary, we have demonstrated the improvement of this symptom after conventional abdominoplasty surgery in most patients.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

UNASSIGNED: It is commonly believed that using abdominal binders or compression garments (CGs) after an abdominoplasty could encourage fluid to drain, which would prevent fluid from building up at the surgical site and reduce the risk of seroma and other similar problems.
UNASSIGNED: To evaluate the effect of the use of abdominal binders or CG on the post-operative outcomes following abdominoplasty.
UNASSIGNED: Systematic review.
UNASSIGNED: Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to select relevant studies from 2004 to 2024. Data from the included studies were extracted to assess the quality and risk of bias using a modified Jadaad score.
UNASSIGNED: Post-operative seroma formation.
UNASSIGNED: Ventilatory function, intra-abdominal pressure (IAP), and subcutaneous edema were the outcomes of interest.
UNASSIGNED: Only 5 trials totaling 130 patients were included in this review. Utilizing post-operative CG following abdominoplasty showed a non-significant tendency to decrease seroma development, ventilatory function, and subcutaneous edema. The limited evidence available also suggested that using post-operative CG increases IAP.
UNASSIGNED: Weak evidence supports the beneficial use of abdominal binders following abdominoplasty.
UNASSIGNED: Low-quality scientific evidence available from the scant data and low caliber of the literature support the use of CG post-abdominoplasty. Therefore, unified outcome reporting and rigid randomized clinical trials are necessary to obtain valid data.