Key result
Midline laparotomy incision shows no benefit over transverse incision for postoperative pulmonary complication severity.
Why the study?
The influence of laparotomy incision direction on the severity of postoperative pulmonary complications was uncertain.
Does midline laparotomy compared to transverse laparotomy reduce postoperative pulmonary complications in patients undergoing major laparotomy?
RCT (n=579)
Does midline laparotomy compared to transverse laparotomy reduce postoperative pulmonary complications in patients undergoing major laparotomy?
The choice between midline and transverse laparotomy incisions does not significantly influence the severity of postoperative pulmonary complications.
Answers are grounded in this paper and cite their sources.
Incision direction may not affect pulmonary complications after laparotomy; leaves open optimal approach in larger confirmatory trials.
In a series of 579 patients undergoing major laparotomy, the direction of incision (midline or transverse/oblique muscle-cutting) was decided randomly. The severity of postoperative pulmonary complications was expressed by a scoring system which allowed categorization into mild (score 0-3), moderate (score 4-6) and serious (score 7 or more) complications. The important determinants of high scores were found to be male sex, preoperative pulmonary dysfunction, postoperative ventilatory depression, hypovolaemic and septic shock, inhalation of gastric contents and embolism. In no stratum did the direction of incision have any significant effect.
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Greenall et al. (1980) conducted an RCT in Major laparotomy (n=579). Midline incision vs. Transverse/oblique muscle-cutting incision was evaluated on Severity of postoperative pulmonary complications. The direction of incision (midline vs transverse/oblique) had no significant effect on the severity of postoperative pulmonary complications in patients undergoing major laparotomy.
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