Hysterectomy — the removal of the uterus — is the second most frequently performed surgery (following cesarean section) for women of reproductive age in the U.S. A panniculectomy is a procedure in which excess skin and tissue, sometimes called a “hanging abdominal,” is removed surgically. The two are both serious procedures, and with them come the risk of complications. A new study, however, has found that combining the two surgeries into once procedure does not actually increase this risk.

Considering the U.S. obesity epidemic, many women scheduled to undergo a hysterectomy are also obese.

“When the obesity is so pronounced that the patient develops a pannis, or “hanging abdomen,” she may become interested in getting rid of the hanging abdominal skin/fat in addition to the original removal of uterus,” said study lead author Dr. Antonio Jorge Forte.

The study analyzed data from a national surgical database on over 25,000 women who underwent hysterectomy between 2005 and 2012. Of these women, 174 underwent panniculectomy during the same operation. The researchers compared 30-day complication rates between women who underwent both procedures at the same time and women who underwent hysterectomy alone.

At first, the team saw that the overall rate of blood clot-related complications was higher for women who underwent both procedures at once: three percent versus one percent for women who only underwent hysterectomy. Women in the combined group were also found to have a more extended hospital stay — 48 percent of them remained in the hospital for three days or longer, compared to 29 percent of the other group.

Patients undergoing the combined hysterectomy and panniculectomy, however, were more likely to be obese, to have diabetes, and to have a history of heart and lung disease. When researchers compared matched groups of patients with similar characteristics, the researchers found no significant difference in blood clot-related complication risk. There was also no difference in surgical site infections, wound complications, medical complications, or total complication rate.

"The significant differences in complications initially identified in our unadjusted analysis were not found after matching patients from both groups," Forte said. "This highlights the critical importance of patient selection for avoiding complications in combined procedures."

The difference in hospital stay, somewhat understandably, remained significant. Women undergoing the combined procedure were twice as likely to spend at least three days in the hospital.

Some surgeons may have concerns about performing hysterectomy and panniculectomy together may increase complication risks. Few previous studies have looked at the safety of this particular combination of procedures.

"Our study indicates that there is a similar complication rate between women who chose to undergo a combined panniculectomy and hysterectomy as compared to those who had hysterectomy alone," Forte said. "However, these patients should be counseled to expect to stay longer in the hospital after combined procedures."

Forte adds that the findings do not end the conversation about the risks of combined procedures, but provide more information to help patients and surgeons make informed decisions.

Source: Forte A, et al. Hysterectomy with Concurrent Panniculectomy: A Propensity-Matched Analysis of 30-Day Outcomes. Plastic and Reconstructive Surgery. 2015.