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Lateral paramedian incision.

T G Brennan1, N A Jones, P J Guillou

  • 1St. James's University Hospital, Leeds, UK.

The British Journal of Surgery
|August 1, 1987
PubMed
Summary
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For abdominal surgery, a lateral paramedian incision requires incising both anterior and posterior rectus sheaths. This technique is crucial for wound integrity and preventing incisional hernias, despite potentially longer surgery times.

Area of Science:

  • Surgical techniques
  • Abdominal surgery
  • Wound healing

Background:

  • The lateral paramedian incision is a common approach in abdominal surgery.
  • The integrity of abdominal wounds is influenced by the method of rectus sheath incision.
  • The 'shutter mechanism' is believed to be essential for wound closure strength.

Purpose of the Study:

  • To evaluate the necessity of incising both anterior and posterior rectus sheaths laterally.
  • To compare the outcomes of standard lateral paramedian incision versus modified techniques.
  • To assess the impact of incision methods on operative time, wound sepsis, and incisional hernia rates.

Main Methods:

  • Prospective randomized study involving 360 patients undergoing abdominal surgery.
  • Three groups were compared: standard lateral paramedian incision (Group A), anterior sheath medial/posterior lateral incision (Group B), and anterior sheath lateral/posterior medial incision (Group C).

Related Experiment Videos

  • Outcomes measured included operative time, wound sepsis, and incisional hernia rates.

    • Main Results:

    • Medial incision of the anterior rectus sheath significantly reduced operative time (P < 0.02).
    • Modified techniques showed a trend towards reduced wound sepsis rates.
    • However, groups B and C exhibited significantly higher incisional hernia rates (2.9% and 4.6%) compared to Group A (0%) (P < 0.02).

    Conclusions:

    • Lateral incision of both anterior and posterior rectus sheaths is necessary for the lateral paramedian approach.
    • This technique is essential to prevent incisional hernias.
    • While modified incisions may reduce operative time and sepsis, they increase the risk of hernia formation.