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Wound complications after primary and repeated midline, transverse and modified Makuuchi incision: A single-center
Sebastian Hempel1, Anne Kalauch, Florian Oehme
1Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Abstract:
There are 3 main types of incisions in major open, elective abdominal surgery: the midline incision (MI), the transverse incision (TI) and the modified Makuuchi incision (MMI). This study aimed to compare these approaches regarding wound complications and hernias, with a special focus on suture material and previous laparotomies.Patients who underwent elective abdominal surgery between 2015 and 2016 were retrospectively analyzed. Uni- and multivariate analyses were computed using stepwise binary and multifactorial regression models.In total, 696 patients (406 MI, 137 TI and 153 MMI) were included. No relevant differences were observed for patient characteristics (e.g., sex, age, body mass index [BMI], American Society of Anesthesiologists [ASA] score). Fewer wound complications (TI 22.6% vs MI 33.5% vs MMI 32.7%, P = .04) occurred in the TI group. However, regarding the endpoints surgical site infection (SSI), fascial dehiscence and incisional hernia, no risk factor after MI, TI, and MMI could be detected in statistical analysis. There was no difference regarding the occurrence of fascial dehiscence (P = .58) or incisional hernia (P = .97) between MI, TI, and MMI. In cases of relaparotomies, the incidence of fascial dehiscence (P = .2) or incisional hernia (P = .58) did not significantly differ between the MI, TI, or MMI as well as between primary and reincision of each type. On the other hand, the time to first appearance of a hernia after MMI is significantly shorter (P = .03) than after MI or TI, even after previous laparotomy (P = .003).In comparing the 3 most common types of abdominal incisions and ignoring the type of operative procedure performed, TI seems to be the least complicated approach. However, because the incidence of fascial dehiscence and incisional hernia is not relevantly increased, the stability of the abdominal wall is apparently not affected by relaparotomy, even by repeated MIs, TIs, and MMIs. Therefore, the type of laparotomy, especially a relaparotomy, can be chosen based on the surgeon's preference and planned procedure without worrying about increased wound complications.
Insights
The transverse incision (TI) had fewer wound complications than midline (MI) or modified Makuuchi incisions (MMI) in abdominal surgery. However, all incision types showed similar rates of fascial dehiscence and incisional hernia, allowing surgeon preference for elective procedures.
Area of Science:
- Abdominal Surgery
- Surgical Incisions
- Wound Complications
Background:
- Major open, elective abdominal surgery utilizes three primary incision types: midline (MI), transverse (TI), and modified Makuuchi (MMI).
- Comparing these approaches is crucial for understanding wound complication and hernia risks.
Purpose of the Study:
- To compare the outcomes of MI, TI, and MMI in elective abdominal surgery.
- To analyze the impact of suture material and previous laparotomies on wound complications and hernias.
Main Methods:
- Retrospective analysis of 696 patients undergoing elective abdominal surgery between 2015-2016.
- Uni- and multivariate regression models were used to identify risk factors.
- Patient characteristics, wound complications (surgical site infection, fascial dehiscence), and incisional hernias were assessed.
Main Results:
- The transverse incision (TI) group exhibited fewer overall wound complications (22.6%) compared to MI (33.5%) and MMI (32.7%).
- No significant differences were found in fascial dehiscence or incisional hernia rates among the three incision types, even after relaparotomy.
- A shorter time to hernia appearance was observed after MMI compared to MI or TI, particularly following previous laparotomies.
Conclusions:
- While TI may present fewer initial wound complications, all three incision types (MI, TI, MMI) demonstrate comparable long-term safety regarding fascial dehiscence and incisional hernias.
- Abdominal wall stability is not significantly compromised by relaparotomy, regardless of the incision type used.
- Surgeons can select laparotomy type based on preference and procedure, without undue concern for increased wound complications.
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