Transverse verses midline incisions for abdominal surgery

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.

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

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

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

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.

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.

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.