BACKGROUND: The aim of this study was to examine whether midline, paramedian, or transverse incisions offer potential advantages for abdominal surgery. DATA SOURCES: We searched MEDLINE, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials from 1966 to 2009 for randomized controlled trials comparing incision choice. METHODS: We systematically assessed trials for eligibility and validity and extracted data in duplicate. We pooled data using a random-effects model. RESULTS: Twenty-four studies were included. Transverse incisions required less narcotics than midline incisions (weighted mean difference = 23.4 mg morphine; 95% confidence interval [CI], 6.9 to 39.9) and resulted in a smaller change in the forced expiratory volume in 1 second on postoperative day 1 (weighted mean difference = -6.94%; 95% CI, -10.74 to -3.13). Midline incisions resulted in higher hernia rates compared with both transverse incisions (relative risk = 1.77; 95% CI, 1.09 to 2.87) and paramedian incisions (relative risk = 3.41; 95% CI, 1.02 to 11.45). CONCLUSIONS: Both transverse and paramedian incisions are associated with a lower hernia rate than midline incisions and should be considered when exposure is equivalent.
BACKGROUND: The aim of this study was to examine whether midline, paramedian, or transverse incisions offer potential advantages for abdominal surgery. DATA SOURCES: We searched MEDLINE, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials from 1966 to 2009 for randomized controlled trials comparing incision choice. METHODS: We systematically assessed trials for eligibility and validity and extracted data in duplicate. We pooled data using a random-effects model. RESULTS: Twenty-four studies were included. Transverse incisions required less narcotics than midline incisions (weighted mean difference = 23.4 mg morphine; 95% confidence interval [CI], 6.9 to 39.9) and resulted in a smaller change in the forced expiratory volume in 1 second on postoperative day 1 (weighted mean difference = -6.94%; 95% CI, -10.74 to -3.13). Midline incisions resulted in higher hernia rates compared with both transverse incisions (relative risk = 1.77; 95% CI, 1.09 to 2.87) and paramedian incisions (relative risk = 3.41; 95% CI, 1.02 to 11.45). CONCLUSIONS: Both transverse and paramedian incisions are associated with a lower hernia rate than midline incisions and should be considered when exposure is equivalent.
Authors: Sarah E Rutstein; Matthew T Siedhoff; Elizabeth J Geller; Kemi M Doll; Jennifer M Wu; Daniel L Clarke-Pearson; Stephanie B Wheeler Journal: J Minim Invasive Gynecol Date: 2015-10-22 Impact factor: 4.137
Authors: Christopher J Goodenough; Tien C Ko; Lillian S Kao; Mylan T Nguyen; Julie L Holihan; Zeinab Alawadi; Duyen H Nguyen; Juan R Flores; Nestor T Arita; J Scott Roth; Mike K Liang Journal: J Am Coll Surg Date: 2015-01-02 Impact factor: 6.113
Authors: F E Muysoms; S A Antoniou; K Bury; G Campanelli; J Conze; D Cuccurullo; A C de Beaux; E B Deerenberg; B East; R H Fortelny; J-F Gillion; N A Henriksen; L Israelsson; A Jairam; A Jänes; J Jeekel; M López-Cano; M Miserez; S Morales-Conde; D L Sanders; M P Simons; M Śmietański; L Venclauskas; F Berrevoet Journal: Hernia Date: 2015-01-25 Impact factor: 4.739
Authors: Matthew T Siedhoff; Stephanie B Wheeler; Sarah E Rutstein; Elizabeth J Geller; Kemi M Doll; Jennifer M Wu; Daniel L Clarke-Pearson Journal: Am J Obstet Gynecol Date: 2015-03-24 Impact factor: 8.661