Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery - 17/08/13
, Paul J. Karanicolas, M.D., Ph.D. b, John B. Ammori, M.D. b, Shiva Jayaraman, M.D., M.E.S.C. b, Jordan M. Winter, M.D. b, Ryan C. Fields, M.D. b, Anand Govindarajan, M.D., M.S.C. b, Itzhak Nir, M.D. b, Flavio G. Rocha, M.D. b, Murray F. Brennan, M.D. bAbstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Incision, Hernia, Midline incision, Transverse incision, Paramedian incision, Meta-analysis
Plan
| The authors declare no conflicts of interest. |
Vol 206 - N° 3
P. 400-409 - septembre 2013 Retour au numéro
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