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Meta-Analysis
. 2005 Oct 19;2005(4):CD005199.
doi: 10.1002/14651858.CD005199.pub2.

Transverse verses midline incisions for abdominal surgery

S R Brown  1 , P B Goodfellow
Affiliations
Meta-Analysis

Transverse verses midline incisions for abdominal surgery

S R Brown et al. Cochrane Database Syst Rev. .

Abstract

Background: The choice of surgical incision in the abdomen is determined by access for surgery. It has been suggested that utilising a transverse or oblique rather than a midline incision may influence other parameters such as recovery and complication rates. However, there is little consensus in the literature as to whether a particular incision confers any advantage.

Objectives: To determine whether a midline incision or a transverse incision (including oblique incision) confers any recovery advantage to the patient.

Search strategy: Search terms included randomised trials containing combinations of the following: 'abdominal', 'incisions', 'horizontal', 'transverse', 'vertical', 'midline', and 'laparotomy'.

Selection criteria: All prospective randomised trials comparing midline with transverse incisions for abdominal surgery were included. Caesarian sections were excluded.

Data collection and analysis: Two review authors assessed the methodological quality of potentially eligible trials and independently extracted data from the included trials. A wide range of outcome measures was considered.

Main results: Due to differences in the method of assessment, the variability of data and the heterogeneity of the participant groups it was difficult to pool some of the outcome data. Despite these limitations, and potentially significant biases related to methodological quality, there was evidence to suggest that a transverse or oblique incision may be less painful and have less impact on pulmonary function than a midline incision, particularly in the early postoperative period. However, there was no difference seen in early or late postoperative complications between a transverse or oblique and a midline incision and recovery times were similar.

Authors' conclusions: Both analgesia use and pulmonary compromise may be reduced with a transverse or oblique incision but this does not seem to be significant clinically as complication rates and recovery times are the same as with midline incision. The methodological and clinical diversity and the potential for bias in the included studies also mean that the results in favour of a transverse or oblique incision, particularly with regard to analgesic use, should be treated with caution. The optimal incision for abdominal surgery still remains the preference of the surgeon.

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Conflict of interest statement

None

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Analgesic use, Outcome 1 Recorded total analgesic use (mg morphine equivalent).
1.2
1.2. Analysis
Comparison 1 Analgesic use, Outcome 2 Analgesic use (mg morphine equivalent) for total hospital stay.
1.3
1.3. Analysis
Comparison 1 Analgesic use, Outcome 3 VAS scores on the first/second post‐operative day.
2.1
2.1. Analysis
Comparison 2 pulmonary function, Outcome 1 Percentage change in vital capacity day 1 post‐operative.
2.2
2.2. Analysis
Comparison 2 pulmonary function, Outcome 2 Percentage change in vital capacity on day 7.
2.3
2.3. Analysis
Comparison 2 pulmonary function, Outcome 3 Percentage change in FEV1 day 1 post‐operative.
2.4
2.4. Analysis
Comparison 2 pulmonary function, Outcome 4 Percentage change in FEV1 last day of measurement.
3.1
3.1. Analysis
Comparison 3 pulmonary complications, Outcome 1 pulmonary complications.
3.2
3.2. Analysis
Comparison 3 pulmonary complications, Outcome 2 Pulmonary complications for elective patients.
4.1
4.1. Analysis
Comparison 4 wound infection, Outcome 1 wound infection.
4.2
4.2. Analysis
Comparison 4 wound infection, Outcome 2 Wound infection excluding Greenall study.
4.3
4.3. Analysis
Comparison 4 wound infection, Outcome 3 Wound infection in elective patients.
5.1
5.1. Analysis
Comparison 5 Wound dehiscence, Outcome 1 wound dehiscence with or without evisceration.
6.1
6.1. Analysis
Comparison 6 Incisional hernia, Outcome 1 incisional hernia rate.
6.2
6.2. Analysis
Comparison 6 Incisional hernia, Outcome 2 Incisional hernia rate (studies with >1 year follow up).
7.1
7.1. Analysis
Comparison 7 hospital stay, Outcome 1 Hospital stay for gallbladder surgery.
7.2
7.2. Analysis
Comparison 7 hospital stay, Outcome 2 Hospital stay forgallbladder surgery (excluding Seenu trial).
7.3
7.3. Analysis
Comparison 7 hospital stay, Outcome 3 Hospital stay for right hemicolectomy.
8.1
8.1. Analysis
Comparison 8 Operation time, Outcome 1 operation time for gallbladder surgery.
8.2
8.2. Analysis
Comparison 8 Operation time, Outcome 2 Operation time for gallbladder sugery (excluding Seenu).
8.3
8.3. Analysis
Comparison 8 Operation time, Outcome 3 Operation time for right hemicolectomy.
9.1
9.1. Analysis
Comparison 9 Incision length, Outcome 1 Length of incision for upper abdominal surgery.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD005199

References

References to studies included in this review

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Ellis 1984 {published data only}
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