The choice of abdominal surgical incision is determined largely by access. However, a transverse incision may be superior to a midline incision in terms of recovery and complications. All randomised controlled trials comparing these incisions were identified. Outcomes included analgesic use, pulmonary function, complication rates and hospital stay. Marked variability in methodology made comparison difficult and potential biases in all of the studies suggests results should be treated with caution. Nevertheless a trend was seen toward less analgesic requirement, less effect on pulmonary function and lower wound dehiscence and incisional hernia rates with a transverse incision. However, the lower pain and reduced effect on pulmonary function were not translated into other clinical advantages as recovery times and other complication rates were similar.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 9, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005199. DOI: 10.1002/14651858.CD005199.pub2

Editorial Group: Colorectal Cancer Group

This version first published online: October 19. 2005
Last assessed as up-to-date: February 1. 2008

Abstract

Background

The choice of surgical incision in the abdomen is determined by access. It has been suggested that other parameters such as recovery and complication rate may be influenced by utilising a transverse or oblique rather than a midline incision. However, there is little consensus in the literature as to whether a particular incision confers any advantage.

Objectives

To determine whether a midline incision or a transverse incision (including oblique incision) confers any recovery advantage to the patient.

Search strategy

Search terms include randomised trials containing combinations of the following: 'abdominal', 'incisions', 'horizontal', 'transverse', 'vertical', 'midline', 'laparotomy'

Selection criteria

All prospective randomised trials comparing midline with transverse incisions for abdominal surgery were included. Caesarian sections were excluded.

Data collection and analysis

Two reviewers assessed the methodological quality of potentially eligible trials and independently extracted data from the included trial. A wide range of outcome measures were considered.

Main results

Due to the differences in the method of assessment, the variability of data and the heterogeneity of the participant groups it was difficult to pool some of the outcome data. Despite these limitations and potentially significant biases related to methodological quality there was evidence to suggest that a transverse or oblique incision may be less painful and have less impact on pulmonary function particularly in the early post-operative period. This incision may also be less prone to rupture (wound dehiscence/incisional hernia). There was no difference seen in other early or late post-operative complications and recovery times were similar.

Authors' conclusions

The analgesia use and the pulmonary compromise may be reduced with a transverse/oblique incision but this does not seem to be significant clinically as pulmonary complication rates and recovery times were the same. The likelihood of wound dehiscence and rupture appears to be reduced with a transverse incision. The methodological and clinical diversity and the potential for bias also mean that the results in favour of a transverse/oblique incision (particularly with regard to analgesic use) should be treated with caution. The optimal incision for abdominal surgery still remains the preference of the surgeon.

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