Low Transverse Abdominal Incision for Baclofen Pump Placement

Intrathecal baclofen pumps are associated with abdominal scars that may be prominent and cosmetically undesirable. At our institution, pumps are placed through a low transverse abdominal incision that may produce less visible scars than standard incisions. This study compared complication rates and clinical efficacy between the two incision types.

This retrospective study included all patients who underwent new subfascial pump implantation at our tertiary children's hospital between 2000 and 2019. Rates of all complications related to intrathecal baclofen therapy were assessed, along with preoperative and 1-year postoperative Modified Ashworth Scale (MAS) scores. Outcomes were compared between unilateral low transverse and standard incisions. Exclusion criteria included implantation through preexisting scars or low transverse incisions that crossed the midline and pumps not filled with baclofen. Numeric and categorical variables were compared using the Wilcoxon rank-sum and chi-square tests, respectively.

Among 160 patients, 107 (67%) experienced at least one complication, 73 (68%) of whom had a low transverse incision and 34 (65%) had a standard incision (p=0.858). Infection or wound breakdown occurred after 20% and 29% of implantations, respectively (p=0.238). Catheter complications occurred in 46% and 44% of cases, respectively (p=0.866). Pump-related complications occurred in 4.6% and 12%, respectively (p=0.178). Median change in MAS scores was smaller in the low transverse group for both upper and lower extremities. However, preoperative MAS scores were also lower in this cohort.

Low transverse abdominal incisions may result in a less visible scar, with complication rates and therapeutic efficacy comparable to standard incisions.