Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery Journal Article

  

Authors:	Bickenbach, K. A.; Karanicolas, P. J.; Ammori, J. B.; Jayaraman, S.; Winter, J. M.; Fields, R. C.; Govindarajan, A.; Nir, I.; Rocha, F. G.; Brennan, M. F.
Article Title:	Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery
Abstract:	Background: The aim of this study was to examine whether midline, paramedian, or transverse incisions offer potential advantages for abdominal surgery. Data Sources: We searched MEDLINE, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials from 1966 to 2009 for randomized controlled trials comparing incision choice. Methods: We systematically assessed trials for eligibility and validity and extracted data in duplicate. We pooled data using a random-effects model. Results: Twenty-four studies were included. Transverse incisions required less narcotics than midline incisions (weighted mean difference = 23.4 mg morphine; 95% confidence interval [CI], 6.9 to 39.9) and resulted in a smaller change in the forced expiratory volume in 1 second on postoperative day 1 (weighted mean difference = -6.94%; 95% CI, -10.74 to -3.13). Midline incisions resulted in higher hernia rates compared with both transverse incisions (relative risk = 1.77; 95% CI, 1.09 to 2.87) and paramedian incisions (relative risk = 3.41; 95% CI, 1.02 to 11.45). Conclusions: Both transverse and paramedian incisions are associated with a lower hernia rate than midline incisions and should be considered when exposure is equivalent. © 2013 Elsevier Inc. All rights reserved.
Keywords:	treatment outcome; postoperative period; laparotomy; bleeding; randomized controlled trials as topic; postoperative complication; postoperative complications; length of stay; pethidine; abdomen; systematic review; operation duration; hernia; gastrectomy; surgical procedures, operative; medline; validity; abdominal surgery; morphine; analgesics, opioid; cochrane library; cholecystectomy; forced expiratory volume; hemicolectomy; wound infection; postoperative pain; visual analog scale; wound dehiscence; wound complication; meta analysis; meta-analysis; embase; randomized controlled trial (topic); spirometry; incision; assisted ventilation; emergency surgery; hemia; midline incision; paramedian incision; transverse incision; ketobemidone; peritoneal dialysis; hernia, abdominal
Journal Title:	American Journal of Surgery
Volume:	206
Issue:	3
ISSN:	0002-9610
Publisher:	Elsevier Inc.
Date Published:	2013-09-01
Start Page:	400
End Page:	409
Language:	English
DOI:	10.1016/j.amjsurg.2012.11.008
PROVIDER:	scopus
PUBMED:	23570737
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84882853117&partnerID=40&md5=66424c4510e00feb1ed0d2b390f56be0
Notes:	--- - Cited By (since 1996):1 - "Export Date: 1 October 2013" - "CODEN: AJSUA" - "Source: Scopus"

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