Background: The abdominal pannus is a well known medical condition of a large overhanging apron of skin and fat that extends well beyond the waistline. There are five degrees of an abdominal pannus from a grade 1 that rests on the mons pubis to a grade 5 that hangs down to the knees. An abdominal panniculectomy procedure should not be confused with a more traditional tummy tuck. 1) Large abdominal panniculectomies can be safely done in an outpatient surgery center if the patient is otherwise healthy. 2) Enough abdominal pannus is removed to relief the obstruction on the pubic area and eliminate any overhang on the groin creases.
3) The most likely complication from any abdominal panniculectomy is a seroma or fluid collection. The abdominal pannus is a stomach deformity where any amount of tissue hangs over the waistline. But despite the popularity and widespread availability of bariatric surgery, not every obese patient undergoes it or is eligible to do so. In the October 2014 issue of the Annals of Plastic Surgery, an article was published entitled “Supersize” Abdominal Panniculectomy: Indications, Technique, and Results’. The relevance of this paper is that it demonstrates that larger abdominal panniculectomies can be done and offer a dramatic improvement in mobility and function of the patient. Not infrequently, there may be a need for a panniculectomy to be done with other abdominal and pelvic procedures such as hernia repair, hysterectomy, and even gastric bypass surgery. Interestingly, an abdominal panniculectomy is not considered medically necessary when the main reason it is being performed is to relieve back, hip and knee pain.
One procedure that is never needed and certainly not medically covered as part of a panniculectomy is liposuction. The abdominal panniculectomy is a variation to the traditional tummy tuck or abdominoplasty.  The pannus  or abdominal apron is that overhang of skin and fat that extends below one’s waistline. The abdominal panniculectomy, historically, refers to the pre-bariatric surgery era when extremely overweight patients had large skin and fat overhangs. The abdominal panniculectomy is different than a true tummy tuck in that the skin edges are not as undermined, no muscles are tightened, and no areas are treated by liposuction.  It is simply an amputation of whatever overhangs the waistline. Because of the relief of medical symptoms, the abdominal panniculectomy may be covered by insurance.
Since the advent of bariatric surgery and the rise in the number of such procedures every year, a traditional body contouring plastic surgery procedure is undergoing a change. Panniculectomy surgery is a reconstructive procedure performed to remove a panniculus, sometimes referred to as a pannus or overhanging abdominal apron.
In the recent past, prior to weight loss from bariatric surgery, an abdominal pannus was quite large (as was the patient) and quite hefty in weight. While removal of a massive abdominal pannus solved a few health problems for the very obese patient, it did little for their general well-being or improve longevity. These sizes of abdominal pannuses are much more manageable, have fewer complications after their removal, and the patients are overall much healthier.
A panniculectomy is a very close cousin to a tummy tuck or abdominoplasty.  The term pannus refers to a large apron of skin and fat that hangs over the waistline. In the historic obese patient, there was a significant improvement in the patient’s quality of life as the skin and infectious symptoms that it caused were eliminated as well as the weight removal improved back and knee pain.
The cost of any type of elective plastic surgery plays a major role in the decision to undergo the procedure(s).
Disclaimer: The information contained on this website should not be construed as medical advice. LAP-Band surgery or Laparoscopic Adjustable Gastric Banding procedure is the least invasive and safest of all the weight loss surgery procedures done for weight loss. The new, small upper stomach pouch limits the amount of food that can be consumed at one time, and a narrowed stomach outlet increases the time it takes for the stomach to empty. LAP-BAND surgery is a tool to help you achieve sustained weight loss by limiting how much you can eat, reducing your appetite, and slowing digestion. What you eat goes through the band and is absorbed, so compliance to healthy foods is still required for optimal results. Least invasive surgical approach – No stomach stapling or cutting, or intestinal re-routing.
Use our Body Mass Index Calculator to help determine if weight loss surgery might be for you. Atlanta Bariatric specializes in advance and comprehensive weight loss management for residents in Georgia, especially patients in metro Atlanta. Register for an in-person or online seminar to learn more about advanced techniques and available information on different types of weight loss surgery. A new study is bringing more evidence that weight-loss surgery in Thailand can erase significantly the risk for diseases such as heart disease hearts for young and middle-aged men and women around the world. Thai Medical offers several options for losing weight but the two most popular weight loss surgeries in Thailand are known as malabsorptive restrictive and restrictive surgeries. According to theA American Obesity Association, the most effective treatment for morbid obesity is bariatric surgery.
Gastric bypass surgery makes up of nearly 75% of all weight loss surgeries in Thailand and works by combining both malabsorptive restrictive approaches.
Consulting a bariatric surgeon in Bangkok or Phuket before you arrive can be very helpful when trying decide which weight loss surgery in Thailand is best for you.
Technically the proper term is a panniculus but it is far more commonly referred to as a pannus. While no abdominal pannus is pleasant for the patient the grade 5 pannus is the most disabling. The scope of the problem being treated would indicate such but how the operation is performed and under what circumstance is also vastly different.
The term, pannus, is derived from a latin word for apron so it is fitting that any overhang is referred to as such.
This still leaves certain patients who are overweight that suffer from a large pannus with all of its associated symptoms.
In this paper, the authors reviewed a series of 26 patients over a six year period that had abdominal panniculectomies performed that weighed over 10 kgs. However, it creates a large abdominal incision and has a lot of ‘dead space’ inside to heal. In the long run it will be very much worth it but expect a healing period of two to three months for a full recovery. This recontouring of the abdominal wall area is exclusively done for cosmetic purposes to create a more flat and firm abdomen. While the pannus produces a stretching of the tissues from the anterior abdominal wall, such effects are not treated by any form of muscle plication as in a tummy tuck.
While it may seem obvious that getting rid of an obstructive pannus could only benefit the results of these surgeries, the insurance companies rarely see it this way.
Even though the sheer weight of grade 4 and 5 pannuses clearly strain these areas, this consideration alone is insufficient for medical coverage.


In fact, thinning out of an abdominal skin flap with liposuction can impact its blood supply and create wound healing problems.
Abdominal pannuses can exist in overweight as well as extreme weight loss patients after bariatric surgery. Heavy pannuses were surgically removed to relieve the medical symptoms that they caused such as skin irritations and rashes from the moisture and heat that builds up underneath it. In the obese patient, this pannus may have considerable weight anywhere from 30 lbs or higher.
Since the panniculectomy procedure in the bariatric surgery patient today weighs considerably less and often only involves improvement of an undesired contour, it is often called cosmetic by one’s health insurance. Because of the amount of excess tissue present, removal may need to extend way into the back and include a vertical cutout as well as that in the horizontal dimension. That procedure is the abdominal panniculectomy…or the cutting off of one’s overhanging pannus.
The pannus frequently contributes to a number of health problems, including chronic wounds and skin infections due to the moisture underneath the skin folds. Many of these pannuses would hang at least down to the middle of the thighs and often to the knees. Along came bariatric surgery and we have seen a fortunate change in the large abdominal pannus patient. The typical pannus that is removed today, often part of a circumferential lower body lift, weighs 10 lbs.
At that time, many abdominal panniculectomy procedures were done to relieve the medical symptoms that the pannus caused. This is different than a true tummy tuck in that the skin edges are not as undermined, no muscles are tightened, and no areas are treated by liposuction.  It is simply an amputation of whatever overhangs the waistline. Because of the relief of medical symptoms, the abdominal panniculectomy  was often covered by insurance. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. The procedure works by limiting the amount of food the stomach can hold after eating, erasing hunger and allowing the patient to be full eating only a small amount of food. When properly adjusted, you will be full eating a small amount of food and your hunger will be gone.
If food is going too quickly through the band, you feel hungry between meals, or you are eating more than a small plate of food to get full – you need a fill. Remember, though, that the LAP-BAND by itself (like other weight loss procedures) will not solve morbid obesity. Our center focuses on variety of treatment methods for bariatric surgery, including gastric bypass, Lap-Band®, band plication, revisional surgery, single incision surgery and robotic surgery. The reluctance of most public health systems around the world and health insurance companies lack ofA  funding weight loss surgeries means that more clients are looking for a solution to reduce the fat and high costs of obesity surgery by traveling to Bangkok or Phuket for a weight loss surgery vacation.
Surgical options for obesity surgery include the gastric band, gastric bypass, RnY Surgery,mini-gastric bypass and gastric sleeve surgery. Gastric bypass surgery in Thailand can be performed via minimally invasive surgery or as an open surgery. This bariatric surgery works by using an inflatable band to squeeze your stomach into two separate sections, a large lower section andA a small upper pouch.
For someone struggling with weight loss, the question isna€™t a€?should I have surgery?a€? but instead, a€?when should i take a weight loss surgery vacation to Thailand?a€?A  Actual Prices and seasonal promotions for having bariatric surgery in Thailand can vary drastically depending on what surgeon, hospital or technique is used. Our weight loss solutions such as: RnY surgery,Lapband or the gastric Sleeve surgery is available in Phuket or Bangkok Thailand so to get started please contact us today. It is a figurine of the meditating Buddha seated in yogic posture, made of a semi-precious green stone, clothed in gold, and about 26 inches tall. It not only obstructs the urinary stream and causes associated hygiene issues but its sheer weight makes mobility difficult. Because of chronic skin infections and urinary obstruction he had been to the hospital numerous times.
There are many large blood vessels that supply the abdominal pannus and intra- as well as postoperative bleeding is always a risk. In days before bariatric surgery, abdominal panniculectomy surgery was very common and it was almost always associated with morbid obesity.
There has been some understandable reluctance to operate on such overweight patients due to the increased risk of complications that is known to occur . As a result, wound complications are common (and to be largely expected) and  revisits to the operating room for their management are not rare.
The abdominal pannus occurs exclusively in morbidly obese individuals or following substantial weight loss, most commonly bariatric surgery.
Citing that there is ‘insufficient scientific literature’ to support any benefit, these combined procedures are usually denied. I have performed over the years numerous panniculectomies that were requested by an orthopedic surgeon to first be done before they would consider knee replacement surgery. The wound edges in closing a panniculectomy are already compromised from chronic swelling and lymphedema in many cases. With an obese patient, panniculectomies were associated with high wound complication rates due to the size and depth of the cut outs.
To be considered medically eligible for insurance coverage, there has to be very specific criteria that are met and a documented trail of medical records that substantiate symptoms related to the pannus.
This does leave long scars but patients with these skin excess problems always feel that it is a good trade-off.
I have seen a few that hung well below the knee and one that hung down and rested on the floor.
As bariatric surgery has helped patients lose a lot of weight, so has the size of abdominal pannuses decreased. Specifically, skin irritations and rashes (known as panniculitis) resulted from the always present moisture and heat in the underlying skin fold. Since the panniculectomy procedure in the bariatric surgery patient  today weighs considerably less and often only involves improvement of an undesired contour, it is often called cosmetic by one’s health insurance. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. The amount of weight you lose depends both on the band and on your motivation and commitment to a new lifestyle and eating habits.
The decision to have surgery should not be taken lightly, please take extra care to thoroughly understand the pros and cons of each surgical technique.
The gastric surgeon in Thailand technique works by dividing your stomach area into two separate areas, and then sealing the lower and upper sections from each other. These two sections will still remain connected, but the area between the two is very small.
We can provide you with actual prices and package promotions once our bariatric surgeons can understand your current medical condition (medical history),along withA your Body mass Index (BMI), and also some pictures so we can get proper recommendations for treatments and prices.A  Researching all your options is a crucial steps that will help you make your weightloss dreams into a reality. It causes tremendous strain on the back and knees and leads to early deterioration of both.


But despite his obvious need for a surgical solution, he stated that no one would take on his case because it was too dangerous or difficult. The operation needs to be performed as expeditiously as possible to get the patient off the operating room table as soon as possible.
Because of bariatric surgery, the most common abdominal panniculectomy today is much smaller and is done after large amounts of weight loss. The indications for surgery were typical including a large amount of overhanging abdominal skin and fat (hangs down to mid-thigh level) that was associated with underlying chronic skin infections, history of panniculitis, and the presence of a hernia.
This type of abdominal surgery should be confused in this regard with the more common tummy tuck. Debate frequently ensues from the insurance company in the medical merits of removing Grade 1 and 2 types. How they can not easily see that such benefits  as improved surgical access and less risks for wound healing problems after surgery is a mystery to me. Apparently, the musculoskeletal problems that it causes by orthopedic specialists is not sufficient evidence for medical coverage. Such surgical removals of abdominal  overhangs today await weight loss through bariatric surgery first, leaving a smaller pannus on a thinner person.
Most importantly, photographs must demonstrate that the pannus hangs onto or below the groin creases.
The biggest complications from these procedures is a seroma or build-up of fluids which is why drains are needed for several weeks after surgery. My personal ‘record’ for an abdominal panniculectomy was a patient who weighted 715 pounds and a pannus that weighed 96 lbs. Most abdominal pannuses that I see today are in the bariatric surgery patient or someone that has lost over 100m lbs.
In some cases, the size of the pannus and its amount of overhang actually cut off some of the blood supply and lymphatic outflow resulting in swelling and infection. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. The weight loss is slower with the band than other surgeries – some people view this is an advantage and some as a disadvantage. The TMV approved treatments are designed for holistic recovery and easy rehabilitation in a minimally invasive manner of rapid weight loss that enables you to have a much faster recovery with significantly less postoperative discomfort.
We can also help you talk to a doctor in Thailand that specializes in surgical weight reduction to find the method that is suited for you. When performing the operation as just an overnight stay, the patient must have few other medical problems and be motivated to get up and moving as soon as possible after surgery. These pannuses are largely skin and the overall health of the patient is generally good since they are more weight appropriate for their height. Of the 26 patients, the mean pannus weight removed was over 15 kgs with a followup period of over a year. A CT scan done before surgery can help discover a hernia which can be very difficult if not impossible to pick up on a physical examination of a large pannus. Such concomitant coverage can be obtained if the documentation of skin problems is first obtained however. Removing these large pannuses required some clever intraoperative methods to hoost them up (known as the ‘china wall’) just to get underneath it to do the cutting. Surgically removing the pannus was common then but the complication rate was high due to the patient’s obesity. We use an ultrasound machine to easily locate the port and guide the fills, so they are quick and relatively painless. Over time, most studies show the weight loss achieved with the band is fairly equivalent to the other quicker weight loss surgeries.
Most important is choosing a surgery that will help to keep the weight off, not just for a little while, but forever. The gastric sleeve surgery in Thailand uses a laparoscope to aid in the removal of about 65%-80% of your stomach. Gastric band weight loss surgery can physically restrict the total amount of food you can consume in any meal. If these mandatory guidelines are not followed by you after surgery,the lost weight may be easily regained. Without adequate written evidence of symptoms, these lower grade abdominal panniculectomies will be viewed as a cosmetic procedure.There is little question that a massive overhanging apron of fat and skin creates chronic and unremitting skin problems underneath it. Because of the magnitude of the abdominal wall resection, wound complications after large abdominal panniculectomies were the norm with fluid build-ups and problems with healing of the incision.
Today, surgical removal of any abdominal overhang would await weight loss through bariatic surgery. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques.
The complications that could occur with the band are generally taken care of easily and safely. The theory behind the surgery is that the smaller your stomach, the less you will have to eat.
This often results in people only eating half to one third of food they normally eat before feeling full. For the out of town patient this means that they will have to get some medical care at home to get it removed.
In addition to the need for enhanced personal hygiene (which is very difficult), treatment of these skin conditions may require antifungal creams and powders and occasionally antibiotics. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery. Using the access port, saline can be injected into the inflatable inner ring within the band to narrow the upper portion of the stomach.
It generally carries no more risk than having your gallbladder removed or some other straightforward surgery. Fat lipotransfers can even be used in other cosmetic surgeries in Thailand to resurface you face with the non-surgical face lift or enlarge the breasts with the stem cell breast augmentation. The rate of major complications, defined as those complications requiring a return to the operating room, was just over 10%. Both provide comprehensive care throughout the entire weight loss surgical process, from the initial consultation to post surgery procedures, follow ups, and beyond.
The other type of surgery is known as Malabsorptive Restrictive surgery.A Malabsorptive surgeries is a slightly more-invasive surgery that works by restricting the overall size of the stomach and also surgically removing parts of your stomachs digestive tract. A sleeve gastrectomy is usually the first in a sequence of weightloss surgeries and usually followed up by a biliopancreatic diversion surgery or gastric bypass that results in much greater weight loss.The gastric sleeve surgery is an temporary measure to help obese clients lose weight temporarily till the point in time when a more definitive surgery can be performed. This type of surgery makes it much harder for you to digest and absorb additional calories thus reducing your weight.



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