Am J Surg 2013 Sep 6;206(3):400-9. Epub 2013 Apr 6.
University of Medicine and Dentistry of New Jersey, New Jersey School of Medicine, Newark, 07103, USA.
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.