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A Comparative Analysis of Fleur-de-Lis and Traditional Panniculectomy after Bariatric Surgery

  • Original Article
  • Body Contouring
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Abstract

Introduction

The Fleur-de-Lis panniculectomy (FdL) adds a vertical component to correct complex contour deformities after massive weight loss by addressing supra-umbilical horizontal skin excess which is not addressed with infra-umbilical transverse panniculectomy (TP). We aim to perform a head-to-head comparison of clinical outcomes and patient reported outcomes (PROs) between FdL and TP.

Methods

A retrospective review of patients ≥18 with a history of bariatric surgery undergoing FdL or TP by a single plastic surgeon between 07/01/2015 and 05/31/2020 was conducted. Surgical site occurrences (SSOs) including surgical site infection (SSI), delayed healing, cellulitis, seroma, hematoma, surgical site occurrences requiring procedural intervention (SSOpi), and a composite of other postoperative outcomes were assessed. In addition, patient satisfaction was analyzed using the Body-Q questionnaire across 12 domains.

Results

The analysis included 56 patients; 26 and 30 patients who were treated with FdL and TP, respectively. Cohorts were statistically similar in terms of age, gender, BMI, and co-morbid conditions. The overall complication rate was 50% (FdL n = 14 (53.9%), TP n = 14 (46.7%); p = 0.592). On multivariate analysis, pannus weight was associated with the development of SSO (p = 0.04). FdL incision, however, was not an independent risk factor for adverse outcomes. Absolute improvement in PROs was similar in both cohorts across multiple domains.

Conclusion

FdL showed a comparable safety and efficacy profile to TP when performed in post-bariatric surgery patients, with equivalent improvement in PROs across multiple domains. Preoperative weight loss should be encouraged in this population as pannus weight is an independent risk factor for complications.

Level of Evidence III

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Abbreviations

FdL:

Fleur-de-Lis panniculectomy

TP:

Infra-umbilical transverse panniculectomy

PROs:

Patient reported outcomes

SSO:

Surgical site occurrence

SSI:

Surgical site infection

SSOpi:

Surgical site occurrence requiring procedural intervention

MWL:

Massive weight loss

EMR:

Electronic medical record

REDCap:

Research Electronic Data Capture

BMI:

Body mass index

HTN:

Hypertension

COPD:

Chronic obstructive pulmonary disease

PVD:

Peripheral vascular disease

ASA:

American Society of Anesthesiology

VTE:

Venous thromboembolism

IQR:

Interquartile ranges

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Acknowledgement

This is a retrospective cohort study approved by the University of Pennsylvania Institutional Review Board. The authors would like to thank Sierra Montoya-Barela for contributing her professional surgical illustrations to this work.

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Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Penn Presbyterian Hospital, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA

    Adrienne N. Christopher, Martin P. Morris, Viren Patel, Robyn B. Broach & John P. Fischer

  2. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Adrienne N. Christopher

  3. Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

    Harrison Davis

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  1. Adrienne N. Christopher
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Correspondence to John P. Fischer.

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Christopher, A.N., Morris, M.P., Patel, V. et al. A Comparative Analysis of Fleur-de-Lis and Traditional Panniculectomy after Bariatric Surgery. Aesth Plast Surg 45, 2208–2219 (2021). https://doi.org/10.1007/s00266-021-02149-y

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