Extended Panniculectomy as a Bridge to Renal Transplantation in a Patient With Morbid Obesity: A Case Report

Panniculopathy associated with morbid obesity can significantly hinder access to kidney transplantation in patients with end-stage renal disease (ESRD), particularly when excessive abdominal volume and overhanging tissue compromise exposure of the iliac fossa. Extended panniculectomy has emerged as a practical pre-transplant optimization strategy, capable of improving anatomic conditions and restoring eligibility in carefully selected candidates. We report the case of a man on hemodialysis whose severe abdominal panniculopathy precluded continuation in the transplant protocol. Despite his markedly elevated body mass index (BMI) and functional limitations, preoperative evaluation demonstrated hematologic stability and multidisciplinary clearance for major surgery. The patient underwent an extended panniculectomy, with en-bloc resection of a massive abdominal pannus and rectus muscle plication. The procedure was completed without hemodynamic instability, and the postoperative course was favorable, characterized by adequate flap perfusion, progressive reduction in drain output, early ambulation, and absence of infectious or ischemic complications. Functional improvement included enhanced mobility, improved local hygiene, and better tolerance to abdominal compression. Correction of the lower abdominal contour subsequently allowed safe surgical access to the iliac fossa, enabling reinstatement into the transplant evaluation pathway. This case report highlights extended panniculectomy as an effective bridge procedure when abdominal morphology constitutes a modifiable barrier to kidney transplantation, rather than an absolute contraindication.