PANNICULECTOMY: More than a tummy tuck
Nursing, Dec 2004 by Gallagher, Susan
After massive weight loss, a patient may be left with a potentially serious new problem: excess abdominal pannus. Here’s the latest on corrective surgery and what to teach him about it.
WHETHER YOUR MORBIDLY obese patient loses a very large amount of excess weight with bariatric surgery or by diet and exercise, he may have a new problem-a large, troublesome abdominal pannus. Sometimes called an abdominal apron, the pannus is a layer of subcutaneous fat that can weigh up to 100 pounds (45.5 kg), depending on how much weight he’s lost. (See Grading the Curve: How Large Is the Pannus?) The extra skin and fat that remain after major weight loss can cause medical and psychosocial problems that impair function and quality of life.
To fully benefit from successful weight loss, the patient may need a reconstructive surgical procedure called panniculectomy. The patient must be nutritionally stable before surgery. Sometimes a patient has a large troublesome pannus removed even if he hasn’t lost weight first. Here, I’ll review the pros and cons of this increasingly common procedure and discuss how to teach and care for your patient.
More than a tummy tuck
Although sometimes thought to be merely cosmetic surgery because of its nickname-the “tummy tuck”-panniculectomy addresses a host of serious problems. (See Problems That Can Be Nipped by Panniculectomy.) But because many third-party payers classify it as an elective cosmetic procedure, your patient may have trouble getting his carrier to pay for it. Thoroughly document his condition to help him establish medical necessity. He’ll need dated photos of the pannus, including front, side, and undersurface views. Some insurance carriers may refuse to pay for the surgery unless the pannus obscures the pubic area or causes intertrigo or other inflammation under the pannus. If all else fails, the patient may need to hire an attorney who specializes in these issues.
Once you’ve helped your patient secure payment for the procedure, prepare him for surgery. If he smokes, encourage him to quit before surgery. Tell him that good nutrition and exercise will help him recover faster. Advise him to ask his surgeon to estimate how long he’ll be hospitalized.
If he weighs more than 300 pounds (136 kg), he’ll require some special accommodation, such as a bed that’s augmentation reno wide enough so he can turn independently, an extra-large walker to help him walk for the first few days, and an overhead trapeze to help him reposition himself. These items may help him maintain his strength and independence and make him less likely to injure himself or his caregivers. Teach him how to use this equipment before he has his surgery.
Nursing care, before and after
As with all patients, provide emotional support throughout your patient’s hospital stay. Remember that he may be embarrassed by his condition, so respect his privacy and help him maintain his dignity.
As you take his history, assess him for risk factors and contraindications. Besides the usual preoperative workup, the patient will need to have endoscopic or radiographic studies to evaluate the primary weight-loss surgery. If he needs revision of the initial surgery, this is probably the time to do it.
Teach him what he needs to know about the surgery and what will be expected of him. Advise him that he may have considerable postoperative pain that requires a patient-controlled analgesia pump, then teach him how to use it. Reinforce what his surgeon has told him about the surgery and what will be expected of him.
Providing postoperative care
After the procedure, monitor the patient for signs and symptoms of complications, such as respiratory compromise, deep vein thrombosis (DVT), skin injury, infection, atelectasis, and bleeding. Prolonged surgery and hypothermia during the procedure increase the risk of complications. Elderly patients, smokers, and hypertensive patients are especially vulnerable, as are patients with chronic illnesses, such as diabetes.
Many patients can turn, walk, and transfer within 8 hours after surgery; others may take longer because of pain or sedation
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