Open cholecystectomy: muscle splitting versus muscle dividing incision: a randomized study

While laparoscopic cholecystectomy has become the standard procedure for symptomatic gallstones, it is likely that 10% of patients will require an open cholecystectomy whether owing to contraindications to the laparoscopic approach or because conversion to the open technique became necessary following laparoscopy. Although the trend towards smaller open cholecystectomy incisions has led to a reduced hospital stay, much of the postoperative morbidity can be ascribed to wound pain. Muscle splitting incisions tend to be less painful than muscle dividing incisions. This randomized consecutive study of elective and emergent open cholecystectomies compared a muscle splitting incision with the traditional muscle dividing technique. The muscle splitting technique was significantly (P < 0.001) less painful than the muscle dividing method as evaluated by the short form of the McGill pain questionnaire. Similarly, a significantly greater proportion of patients were fully mobile on the first and second postoperative day in the muscle splitting group compared with the muscle dividing group. Analgesia requirements, however, were not statistically significant between the two groups. We recommend that when open cholecystectomy is necessary the muscle splitting technique should be employed.