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AAPS 85th Annual Meeting
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Reconstruction of abdominal wall defects after bariatric surgery and simultaneous abdominal lipectomies
Mimis Cohen, MD, Mark Allen Grevious, MD, Joseph Vitello, MD.
University of Illinois, Chicago, IL, USA.

Purpose: Plastic surgeons are often called to manage post bariatric surgery abdominal wall complications alone or jointly with a general surgeons. The purpose of this work was to evaluate outcomes of abdominal lipectomies when combined with reconstruction of ventral hernias or other major abdominal wall defects.
Methods 327 patients were treated from 1991 to 2004. 211 were treated exclusively by our service and 116 jointly with general surgeons. 229 presented with primary ventral hernias, 12 with other hernias around port sites and 86 with recurrent hernias. 55.9% of incisional hernias were treated using the components separation technique, 11.1% with direct approximation and 33 % with a biomaterial. A Fleur-de -Lis lipectomy was used in the vast majority of cases since they presented with a vertical scar from previous procedures.
Results: Our follow-up ranged from 1 to 8 years. 2.1% of the patients developed PE and required long term treatment, 7.3% developed seromas and 0.65% hematomas. There were 16.1% minor wound problems, treated conservatively, and 8.2% major infections and dehiscences that required wound care and additional surgical procedures. 5.8% of our patients developed recurrent hernias.
Conclusions: Our results indicate that abdominal lipectomies can be combined with abdominal wall reconstruction without a significantly higher risk of complications. Procedures should be individualized and based on reconstructive requirements and patients’specific needs. Wound complication should be managed aggressively with early debridement and closure, while staged reconstruction should be considered when early definitive closure is not feasible or desirable.

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