Transverse verses midline incisions for abdominal surgery

Abstract

The choice of surgical incision in the abdomen is determined by access. It has been suggested that other parameters such as recovery and complication rate may be influenced by utilising a transverse or oblique rather than a midline incision. However, there is little consensus in the literature as to whether a particular incision confers any advantage. To determine whether a midline incision or a transverse incision (including oblique incision) confers any recovery advantage to the patient. Search terms include randomised trials containing combinations of the following: 'abdominal', 'incisions', 'horizontal', 'transverse', 'vertical', 'midline', 'laparotomy' All prospective randomised trials comparing midline with transverse incisions for abdominal surgery were included. Caesarian sections were excluded. Two reviewers assessed the methodological quality of potentially eligible trials and independently extracted data from the included trial. A wide range of outcome measures were considered. Due to the 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 has less impact on pulmonary function particularly in the early post‐operative period and is less prone to rupture (wound dehiscence/incisional hernia). The data on pain is less clear and should be interpreted with caution but some data suggests a transverse incision is less painful. There was no difference seen in other early or late post‐operative complications and recovery times were similar although the transverse incision may be cosmetically more acceptable. The analgesia use and the pulmonary compromise may be reduced with a transverse/oblique incision but this does not seem to be significant clinically as pulmonary complication rates and recovery times were the same. The likelihood of wound dehiscence and rupture appears to be reduced with a transverse incision and a transverse incision may look better. The methodological and clinical diversity and the potential for bias also mean that the results in favour of a transverse/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. 使用橫向切口或是中央切口進行腹部手術 進行手術的醫師會為患者評估要在腹部使用的切口方式，目前有人推測使用橫向或是傾斜的切口，而不是中央切口的方式，可能會影響一些其他恢復率或是併發症產生率之類的參數，但是，在文獻中少有提到一些關於是否特殊切口可以提供一些優點的共識 本研究的主要目的在於研究中央切口或橫向切口(包括傾斜性切口)對於患者的復原是否可以提供任何優點 本研究係針對包含有下列關鍵字的隨機性試驗進行檢索：腹部的(‘abdominal’)、 切口(‘incisions’)、水平的(‘horizontal’)、橫向的(‘transverse’)、垂直的(‘vertical’)、 中央的(‘midline’)和剖腹手術(‘laparotomy’) 所有比較中央切口和橫向切口對於腹部手術影響的前瞻性隨機試驗都會被納入本研究中，其中剖腹生產的研究會被排除於研究之外 有2位審閱作者會評估可能被納入研究的試驗其方法品質，並且個別由納入的試驗中取出數據，考量較廣泛的試驗成果 因為不同的評估方法，數據之間的變異度和受試者分組的異質性使得要將某些試驗成果數據匯集是十分困難的，儘管有上述限制，且方法品質有潛在性的顯著偏差，仍然出現一些可以說明橫向性或斜向性切口比中央切口更可以降低疼痛發生和對肺部功能影響的證據，特別是在剛結束手術的較早期時期，但是使用橫向性或斜向性切口和中央切口對於結束手術後的早期或晚期併發症並沒有出現差異性，且兩種切口方式所需的復原時間也是十分相似的 進行橫向性或斜向性切口時，麻醉藥的使用量或是肺功能(pulmonary compromise)都可能降低，但是在臨床上，例如併發症的發生率和恢復時間來說，使用橫向性切口或中央切口在臨床上並沒有顯著的差異性，本研究所納入的試驗其方法學品質、臨床上的變化性和潛在的偏差都傾向於支持使用橫向性及斜向性切口，尤其是在論及使用麻醉藥的需求時，更應該謹慎的進行處理。腹部手術使用的切口仍然和操刀醫師的偏好有關 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌 相對於進行中央切口來說，在腹部進行橫向切口可能可以降低患者的疼痛，並且較不會對肺部功能產生影響，但是這兩種切口方式對於患者復原情形及併發症發生率來說都是十分相似的，腹部手術切口的選擇大多仍仰賴醫師的評估，但是橫向性切口在恢復狀態及併發症發生等因素上會優於中央切口，所有針對這兩個方法進行比較的隨機性對照試驗都受到確認，治療成果包括使用麻醉藥、肺部功能、併發症發生率和住院時間等，使用方法學上的顯著變異性使得比較的工作更不容易進行，且在所有試驗都存在有潛在性偏差，因此要進行治療時必須要格外謹慎，研究的結果叫較傾向於支持可以降低麻醉藥使用量，也可以降低對肺部功能影響的橫向性切口，但是這些因素並未被轉換為臨床上的優勢，因為兩種方法在恢復時間和併發症發生率上的結果十分相似 Transverse verses midline incisions for abdominal surgery Le choix de l’incision chirurgicale dans l’abdomen est déterminé par...