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Midline Versus Transverse Incision in Major Abdominal Surgery A Randomized, Double-Blind Equivalence Trial

Midline Versus Transverse Incision in Major Abdominal Surgery A Randomized, Double-Blind Equivalence Trial. Paper of The Week.

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Midline Versus Transverse Incision in Major Abdominal Surgery A Randomized, Double-Blind Equivalence Trial

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  1. Midline Versus Transverse Incision in Major Abdominal SurgeryA Randomized, Double-Blind Equivalence Trial Paper of The Week Christoph M. Seiler, MD, Andreas Deckert, MSc, Markus K. Diener, MD, Hanns-Peter Knaebel, MD,Markus A. Weigand, MD,Norbert Victor, PhD, Markus W. Bu¨chler, MD Published June 2009 Mamoun A. Rahman Mr Osborne’s team

  2. Objective • The aim of this study is to compare transverse and longitudinal approaches by focusing on: -Postoperative pain -Complications -Frequency of incisional hernias

  3. Methods • Conducted in Departments of General Surgery and Anesthesiology, University of Heidelberg • Eligibility criteria: - Elective laparotomy - Stomach procedure, - Colonic and - Pancreatic procedures suitable for both approaches • Random allocation to either transverse or midline incision was performed with opaque sealed envelopes

  4. Results • Study period:18/09/03 – 2/03/06 • 101 midline vs. 99 transverse incisions • Post operative pain -Piritramide (mg/h) was 1.08 for midline,1.04 for transverse in the first 24 hrs -Visual Analogue Scale was 13/100 versus 17/100 in day two statistically no significant difference

  5. Results • Complications: ( 1 month) -Wound infections: 15 transverse vs. 5 midline (P= 0.02) -Burst abdomen: 1 vs. 0 -Pulmonary complications :17 vs. 13 (P 0.43) -Overall mortality within one month: 2 vs. 2 (P 0.99) -Hospital stay: median 12 vs. 11days (P 0.08)

  6. Results • Incisional hernias: -8 in the transverse and 13 in the midline (P =0.48) -Wound infection was not significantly related to incidence of incisional hernias (midline 12/83 vs. 1/4, Fisher exact test P 0.50; transverse 5/79 vs. 3/12, P 0.09)

  7. Conclusion • Both incision types can be used without any relevant consequences for the patient • The decision about the incisions should be guided by the planned surgical procedure

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