Panniculectomy—an option for people who are morbidly obese - Home Study Program

AORN Journal,  April, 2003  by Marilyn Payer,  Barbara Youngberg,  Shirley Pfister

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The article "Panniculectomy--An option for people who are morbidly obese" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

A minimum score of 70% on the multiple-choice examination is necessary to earn 3.4 contact hours for this independent study. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is April 30, 2006.

Send the completed application form, multiple-choice examination, learner evaluation, and appropriate fee to

AORN Customer Service
c/o Home Study Program
2170 S Parker Rd, Suite 300
Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

BEHAVIORAL OBJECTIVES

After reading and studying the article on the panniculectomy procedure for people who are morbidly obese, the nurse will be able to

(1) define body mass index,

(2) compare treatment options available to people who are morbidly obese,

(3) describe the team approach to preparing patients for the panniculectomy procedure so that potential complications can be avoided,

(4) discuss the perioperative experience of a patient undergoing panniculectomy, and

(5) explain what a patient experiences when recovering from the panniculectomy procedure.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

Obesity is becoming a major health Issue across the nation. Surgical procedures to alleviate problems of severely limited ambulation, development of open wounds, and overeating may be an option for people who are morbidly obese. A gastric bypass procedure and panniculectomy are among the surgical options available. In this article, the preoperative, intraoperative, and postoperative care of a patient undergoing a panniculectomy are presented. A safe, complication-free procedure can be performed with preplanning; a precise, detailed team effort; and an informed, motivated patient. AORN J 77 (April 2003) 782-794

Obesity has reached epidemic proportions worldwide. This disease is neither gender nor age specific; however, it has been reported that obesity is seen more frequently in women of Hispanic and African-American descent. (1) It also is seen within the native Hawaiian and Alaskan communities. (2) The convenience of fast foods high in fat and calorie content and a less demanding physical lifestyle contribute to this life-threatening problem. (3) Additionally, obesity plays a role in other health complications, including diabetes, hypertension, asthma, cardiac and vascular disease, and back and joint pain. (4)

SCREENING AND TREATMENT OPTIONS

Screening for obesity can range from simple mathematical calculations to sophisticated x-ray techniques. The most frequently used calculation is body mass index (BMI). This formula is based on an individual's weight in kilograms divided by the square of his or her height in meters. The International Obesity Task Force has used BMI to identify three groups:

* normal BMI (ie, 18.9 to 24.9),

* overweight BMI (ie, 25 to 29.9), and

* obese BMI (ie, 30 or greater). (5)

Morbid obesity can be defined in one of three ways:

* weighing 100% or more than ideal body weight,

* weighing at least 100 pounds more than ideal body weight, or

* having a BMI greater than 35. (6)

The waist to hip circumference ratio (WHR) is another obesity screening method. Complications resulting from obesity are observed when the WHR is greater than 1.0 in men and 0.8 in women.

Treatments for obesity are complex and multifaceted. They include lifestyle changes, medication therapy, and surgical interventions.

Lifestyle changes. Lifestyle changes consist of numerous types of behavioral modification, including decreasing caloric intake and increasing calories spent. Lifestyle changes also encompass psychological evaluation and therapy sessions to expose the root cause of the obesity. Support groups and web sites are available to help people deal with their condition. Obesity is a complicated disease and carries with it problems affecting personal hygiene, body image, and interpersonal relationships. (7)

Medication therapy. Prescribing medication for the treatment of obesity is a controversial issue. (8) Appetite suppressants, such as sibutramine, can further compound preexisting conditions. (9) Appetite suppressants do not alleviate the problem if the person does not participate in a prescribed calorie reduction diet. Lipase inhibitors, such as orlistat, also must be used in conjunction with a weight reduction diet. (10) The person must be aware fully of the precautions and risks of taking any medications and must be willing to comply with dietary restrictions.

Surgical interventions. Liposuction and bariatric procedures are types of surgical interventions available. Gastric bypass, abdominoplasties, and panniculectomy are common bariatric procedures. A BMI greater than 40 or greater than 35 with significant cardiopulmonary problems or diabetes mellitus is the currently accepted criteria for consideration of bariatric surgery. Panniculectomy is an exaggerated tummy tuck, and a patient's panniculus (ie, fatty apron) is graded on a scale of one to five, with five being the most severe (Table 1). A large panniculus compounds an individual's difficulties with obesity problems. (11) Activities of daily living are extremely difficult for someone with a large panniculus. Skin excoriation and breakdown occur as a result of pressure and moisture buildup from the fatty apron. (12) Panniculectomy often is done in conjunction with gastric bypass. (13)