Background:
Panniculus morbidus is a debilitating condition associated with severe obesity, characterised by massive abdominal pannus formation, lymphoedema, recurrent infection, and profound functional impairment. In advanced disease, weight loss alone is insufficient, and surgical resection may be necessary. Access to complex panniculectomy in regional centres remains limited.
Methods:
We report a case of massive panniculus morbidus managed at a secondary regional hospital. A 51-year-old man with a BMI of 74 developed a progressively enlarging abdominal pannus, secondary to obesity and lymphoedema. He experienced severe mobility limitation, social isolation, and recurrent infections, including an ICU admission with life-threatening pannus cellulitis. Despite 26kg weight loss under bariatric supervision, the pannus progressed to ground level. A multidisciplinary decision was made to proceed with functional panniculectomy. Preoperative planning included CT imaging, infectious diseases consultation, and theatre modification with a hoist rig system.
Results:
A combined general and plastic surgical approach was undertaken. The pannus was suspended using Steinmann pins and a hoist rig, allowing adequate traction for dissection, which was undertaken using an abdominoplasty approach by two surgical teams. A 49 kg pannus was excised en bloc. Resulting abdominal wall defect was repaired and rectus divarication was plicated.
Postoperative care involved a multidisciplinary approach with early mobilisation, allied health input, antibiotic therapy and involvement of the community nursing team. A delayed wound collection was treated successfully with intravenous antibiotics. Minor wound breakdown resolved with conservative care. At 4 months, wounds were fully healed, with marked improvement in mobility, independence, and quality of life.
Conclusion:
Massive functional panniculectomy is a life-changing intervention that can be safely delivered in a regional hospital with appropriate multidisciplinary planning, improving access to essential reconstructive care.