[The Pfannenstiel incision in colorectal surgery]

A parietal incision derived from Pfannenstiel's incision has been used since 1983 for surgery of the left colon and rectum. We conducted a prospective study in 100 patients with a mean age of 61 years who underwent surgery from 1984 to 1987 to assess the parietal outcome, postoperative pain and respiratory impact. The most frequent procedures were: sigmoidectomy (n = 48), anterior resection of the rectum (n = 24), rectopexia (n = 12), amputation of the rectum (n = 5) and total colectomy (n = 5). The splenic angle was mobilized in 23 cases. The operation also included a procedure to relieve occlusion in 4 patients. Operative mortality was nil. Parietal complications were bleeding (n = 4) or infection (n = 8). Seven early reoperations used the same access. Mean follow-up for 61 patients was 75 months. No cases of eventration were observed despite factors predictive of failure. Ventilatory impact, as measured by spirometry showed ventilatory peak-flow and blood gases comparable to those observed after a medial hypogastric incision. Pain, assessed on the bases of a visual analog scale and use of antalgesics, was considered to be mild on day 1, low on day 2 and absent on day 5. Sixty-five percent of the patients did not require antalgesics. In conclusion, this incision creates a hypogastric minilaparotomy allowing midline sub- and peri-umbilical, or even xyphoidial access with little pain and operative risk as the parietal risk is eliminated. Oral nutrition and activity can be resumed rapidly, reducing surgical stress in a protocol for minimally-invasive surgery.