This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Randomized prospective comparison of postoperative pain control and respiratory complications following midline or transverse laparotomy for aortic surgery. BJS 2001; 88: 611-612.
Published: 6th December 2002
Authors: P. P. Tekkis, J. Krysa, S. Chan, A. Challiner, L. M. South, S. M. Andrews et al.
Background
Transverse abdominal incisions are thought to be less painful and followed by fewer pulmonary complications than midline incisions, but reports remain controversial. This study compared midline and transverse incisions for elective transabdominal aortic aneurysm repair with respect to postoperative pain, respiratory function and pulmonary complications.
Method
Sixty patients were randomized to midline laparotomy and transverse incisions, and evaluated before and after operation for 7 days at regular intervals. Analgesia was provided via a thoracic epidural and pain scores were recorded by means of a visual analogue scale. Respiratory function (peak expiratory flow rate, forced expiratory volume in 1 s and forced vital capacity) and pulmonary complications were monitored as well as patient characteristics, operating time, blood loss, operative exposure, and length of stay on the intensive care unit (ITU) and in hospital.
Results
The two groups included a similar number of patients (n = 30 per group) and basic characteristics such as age and preoperative risk factors. Linear analogue pain scores were significantly lower in the transverse group of patients (P < 0·001). There was no significant difference between the two groups with regard to postoperative ventilatory function and respiratory complications as well as analgesic requirements, operating time, blood loss, and length of ITU and hospital stay.
Conclusion
The direction of incision does not seem to influence the incidence of respiratory complications. However, a transverse incision in combination with a high epidural analgesia seems to offer better postoperative pain control. © 2001 British Journal of Surgery Society Ltd
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