Outcomes of Abdominal Panniculectomy With or Without Concomitant Ventral Hernia Repair in a High-risk Cohort

Background: Panniculectomy is often performed after bariatric surgery and is increasingly combined with ventral hernia repair (VHR), yet the effect of concomitant VHR compared with panniculectomy alone on outcomes remains debated. We aimed to compare outcomes of panniculectomy performed with or without concomitant VHR and to determine whether bariatric history, transplant history, or other clinical factors independently predicted complications and postoperative interventions in a contemporary single-surgeon cohort. Methods: A retrospective review of 127 adults undergoing abdominal panniculectomy with or without concomitant VHR by a single surgeon (2019–2024) was conducted. Demographics, comorbidities, operative variables, and outcomes were analyzed. Univariate and multivariable logistic regression identified predictors of complications, reoperation, and postoperative intervention. Results: Concomitant VHR was performed in 38 (29.9%) patients. Complications occurred in 31.5%, reoperation in 15.7%, and postoperative intervention in 18.9% of patients. Outcomes were similar between VHR with panniculectomy and panniculectomy alone (complications, 26.3% versus 33.7%; relative risk, 0.78; 95% confidence interval, 0.43–1.43; P = 0.532). In adjusted analyses, concomitant VHR was not associated with complications, reoperation, or postoperative intervention. Abdominal surgical history was the only significant predictor of intervention (adjusted odds ratio, 7.9; 95% confidence interval, 2.6–24.0; P < 0.001). Conclusions: Concomitant VHR during panniculectomy can be performed safely without increased wound morbidity. The comparatively low rates of reoperation and postoperative intervention may reflect a structured perioperative optimization pathway. Scar burden—not body mass index or transplant status—remains the dominant predictor of postoperative intervention, emphasizing the need for individualized counseling and wound-management planning.