Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery

Kai A. Bickenbach, Paul J. Karanicolas, John B. Ammori, Shiva Jayaraman, Jordan M. Winter, Ryan C. Fields, Anand Govindarajan, Itzhak Nir, Flavio G. Rocha, Murray F. Brennan

Research output: Contribution to journalReview article

35 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)400-409
Number of pages10
JournalAmerican journal of surgery
Volume206
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

Keywords

  • Hemia
  • Incision
  • Meta-analysis
  • Midline incision
  • Paramedian incision
  • Transverse incision

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    Bickenbach, K. A., Karanicolas, P. J., Ammori, J. B., Jayaraman, S., Winter, J. M., Fields, R. C., Govindarajan, A., Nir, I., Rocha, F. G., & Brennan, M. F. (2013). Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. American journal of surgery, 206(3), 400-409. https://doi.org/10.1016/j.amjsurg.2012.11.008