A comparison of circumumbilical and transverse abdominal incisions for neonatal abdominal surgery

Purpose

Although neonatal bowel surgery traditionally involves a transverse abdominal incision, several authors have reported that the circumumbilical incision is effective and cosmetically appealing. We report the first study comparing the circumumbilical incision to the transverse abdominal incision for a variety of neonatal abdominal operations.

Methods

Retrospective cohort analysis comparing the circumumbilical incision to the transverse abdominal incision for neonates who underwent surgical repair of malrotation, duodenal atresia/web, or intestinal atresia/web was performed between 1999 and 2009.

Results

One hundred thirty-two patients underwent a laparotomy through a transverse abdominal incision (n = 106) or a circumumbilical incision (n = 26). Baseline characteristics between groups were similar. No differences were found when comparing operative time, postoperative days on a ventilator, narcotic infusion, time to full feeds, length of hospital stay, incidence of surgical site infection, and bowel obstruction. Although more incisional hernias occurred in the circumumbilical incision group (38%) than the transverse abdominal incision group (6%), all hernias in the circumumbilical group resolved without intervention, whereas 33% required surgical repair in the transverse abdominal group.

Conclusions

Because of its cosmetic advantages and similar outcomes to the transverse abdominal incision, the circumumbilical incision should be considered as an alternative to the transverse abdominal approach in neonatal surgery.     

Testicular sperm retrieval method: histological effects of location of incision

This research was conducted to evaluate the effects of a transverse vs. longitudinal incision for testicular sperm retrieval. Rats were divided into 4 groups: I: control, II: sham operation, III: longitudinal incision TSRM, IV: transverse incision TSRM. Group II (sham operation) had a dissection of left testis/spermatic cord, then closure of wound. Group III underwent dissection of left testis, then a "longitudinal" incision (15 mm long) of testis, which was fully opened then closed again and sutured with 5-0 Vicryl sutures. Group IV underwent dissection of the left testis, opening of the testis with a "transverse" incision, then closure with 5-0 Vicryl. The seminiferous tubule diameter was 0.118-0.224 mm in all groups. Inflammation and abscess formation occurred in one testis each in the sham and longitudinal incision groups, and in two testes in the transverse incision group. There were no differences in histopathology or scoring between the longitudinal and the transverse incision.     

腹部皮肤横切口在前列腺切除术中的应用研究

目的:探讨腹部皮肤横切口在耻骨上前列腺切除术中的优势。方法:于2001年2月至2004年9月期间,将41名因BPH行耻骨上前列腺切除术的患者随机分为纵切口组20例及横切口组21例。并对两组的结果进行比较和统计分析。结果:横切口在术中及术后出血量、切口长度以及术后肛门恢复排气时间上均优于纵切口,差异有统计学意义(P<0.05)。结论:与腹部皮肤纵切口耻骨上前列腺切除术相比,皮肤横切口术式具有暴露好、术中及术后出血少、手术时间短、术后肠道功能恢复较快、切口愈合好且较美观等优点,值得临床推广应用。     

Modified Pfannenstiel approach for radical retropubic prostatectomy

Radical retropubic prostatectomy is traditionally performed using a vertical midline incision and occasionally using a transverse Pfannenstiel incision. We describe a technique for performing radical retropubic prostatectomy using a modified Pfannenstiel approach. This involves a Y incision of the rectus sheath, instead of a pure transverse incision, and provides both excellent exposure and better cosmetic results.     

横切口在早期乳腺癌手术中的运用分析

目的分析早期乳腺癌的手术切口选择方式。方法将68例早期乳腺癌病人随机分为2组，一组病人采用纵切口实施改良根治术，另一组采用横切口实施改良根治术，比较两组病人术后并发症。结果纵切口术式并发症较横切口并发症明显增多。结论早期乳腺癌宜首选横切口术式。     

Choice of incision and pain following gallbladder surgery

A prospective randomized trial compared pain in the first 24 h after gallbladder surgery via an upper midline or a transverse incision. Pain was measured by the patients' self-administered consumption of pethidine, degree of postoperative respiratory impairment and a visual analogue pain scale. The upper midline incision group self-administered significantly more pethidine than the transverse incision group (P less than 0.001), but there was no difference between the groups in respiratory function or visual analogue pain scale results 24 h after operation. Length of hospital stay was not different. An upper midline incision is more painful than a transverse incision in the first 24 h following gallbladder surgery.     

腹壁切口疝与横、纵切口选择的关系——Meta分析

目的比较腹部横切口与纵切口两种不同方式与切口疝发生率之间的关系。方法通过检索PubMed、EMBASE数据库中与之相关的随机对照试验(randomized controlled trials,RCTs)和队列研究(cohort study),并辅以手工检索和文献追溯法收集1990年1月1日至今公开发表的关于腹部切口发生切口疝的相关文献,对最终纳入的文献采用Stata(12.0版)软件进行Meta分析。结果通过数据库检索出文献502篇,根据入选标准和排除标准,通过阅读全文最终纳入22篇研究文献,共累计病例5 405例,其中发生切口疝的病人共654例,切口疝总发生率为12.1%,Meta分析结果显示腹部横切口的切口疝发生率为4%,而腹部纵切口的切口疝发生率为10%。不考虑权重的情况下进行横向切口与纵向切口疝发生率的t检验,发现两者差异有统计学意义(P0.000 1)。结论横向切口可能是预防腹部手术后切口疝发生率高的优选切口。     

Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision

Objectives  To determine whether a transverse incision is an alternative to a midline incision in terms of incisional hernia incidence, surgical site infection, postoperative pain, hospital stay and cosmetics in cholecystectomy. Summary background data  Incisional hernias after midline incision are commonly underestimated but probably complicate between 2 and 20% of all abdominal wall closures. The midline incision is the preferred incision for surgery of the upper abdomen despite evidence that alternatives, such as the lateral paramedian and transverse incision, exist and might reduce the rate of incisional hernia. A RCT was preformed in the pre-laparoscopic cholecystectomy era the data of which were never published. Methods  One hundred and fifty female patients were randomly allocated to cholecystectomy through midline or transverse incision. Early complications, the duration to discharge and the in-hospital use of analgesics was noted. Patients returned to the surgical outpatient clinic for evaluation of the cosmetic results of the scar and to evaluate possible complications such as fistula, wound dehiscence and incisional hernia after a minimum of 12 months follow-up. Results  Two percent (1/60) of patients that had undergone the procedure through a transverse incision presented with an incisional hernia as opposed to 14% (9/63) of patients from the midline incision group (P = 0.017). Transverse incisions were found to be significantly shorter than midline incisions and associated with more pleasing appearance. More patients having undergone a midline incision, reported pain on day one, two and three postoperatively than patients from the transverse group. The use of analgesics did not differ between the two groups. Conclusions  In light of our results a transverse incision should, if possible, be considered as the preferred incision in acute and elective surgery of the upper abdomen when laparoscopic surgery is not an option.     

腹腔镜下直肠癌根治术下腹部辅助切口选择的临床研究

目的探讨腹腔镜下直肠癌根治术采用下腹部辅助纵切口(简称纵切口)与耻骨上辅助横切口(简称横切口)两种切口方式的优劣。方法回顾性分析2012年8月至2015年12月行腹腔镜直肠癌根治术并有术后完整随访记录的患者临床资料,按腹部辅助切口方式分成纵切口组和横切口组,术后采用复查随访,随访时间截止至2016年5月。采用SPSS 19.0软件,术中手术指标、术后疼痛评分数据以x珋±s表示,采用t检验;术后并发症发生率比较采用卡方检验。P0.05认为差异有统计学意义。结果有93例患者纳入了本次研究,纵切口组42例,横切口组51例。两组患者在手术时间、术中出血量、肿瘤大小、术后通气时间、术后住院时间等差异无统计学意义(P0.05);横切口长度为(4.4±0.8)cm,纵切口长度为(4.9±0.7)cm,两组比较差异有统计学意义(P0.05);术后疼痛评分(VAS评分),横切口组在24 h和72 h低于纵切口组,差异有统计学意义(P0.05);纵切口组术后切口感染率为14.3%,横切口组术后切口感染率为2.0%,两组比较差异有统计学意义(P0.05)。结论腹腔镜下直肠癌根治术采用耻骨上横切口在减少术后切口相关并发症方面明显优于下腹部纵切口,值得临床应用和推广。     

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目的 评价横切口腹膜外单层缝合法在阑尾切除术中的临床应用效果。方法 2004年8月至2006年12月南方医科大学附属郴州医院和中山大学附属第三医院行724例右下腹切口阑尾切除术，随机采用横切口腹膜外单层缝合或常规麦氏（或横）切口分层缝合方法，对其疗效进行对比分析。结果 采用横切口腹膜外单层缝合法（单层缝合组）行化脓性、坏疽性阑尾切除者，其手术时间、术后住院时间、切口感染率等方面明显低于常规分层缝合法者（分层缝合组）（P〈0.01）；两组术后疼痛程度差异无统计学意义（P〉0.05）。单纯性阑尾炎切除病人中。横切口腹膜外单层缝合法与常规分层缝合法比较，临床效果无优越性（P〉0.05），疼痛程度明显增加（P〈0．01）。结论 右下腹横切口腹膜外单层缝合法具有操作简单、安全、并发症少的优点，应做为化脓性和坏疽性阑尾炎开腹阑尾切除术的标准方法。右下腹切口的分层缝合法应做为单纯性阑尾炎开腹阑尾切除术的首选方法。     

Longitudinal incision in surgical release of De Quervain disease

The objective of this paper is to contrast the use of a longitudinal incision in surgical decompression of De Quervain disease with a transverse incision. The advantages are ease in recognition of compartment variations and superficial branches of radial nerve and prevention of palmar tendon subluxation by permitting a more dorsal release of the compartment sheath. Since 2002, we have used a longitudinal skin incision instead of the classic transverse incision to release the first dorsal compartment.     

超声引导下改良塞丁格技术行PICC置管两种扩皮角度的比较

目的比较超声引导下改良塞丁格技术行PICC置管两种扩皮角度的临床效果。方法将100例PICC置管患者随机分为两组各50例。成功置入导丝后,纵切组90°扩皮即刀刃向上与皮肤垂直扩皮,横切组180°扩皮即刀刃与皮肤平行扩皮。结果纵切组扩皮后即刻、置管后24h及7d出血量显著少于横切组,扩皮后疼痛程度显著轻于横切组(均P0.01);纵切组一次送鞘成功率(100%)高于横切组(90.0%)。结论超声引导下改良塞丁格技术行PICC置管扩皮时采用纵切法可有效减少扩皮后出血,减轻患者疼痛,提高一次送鞘成功率。     

Abdominal incisions and staging in ovarian cancer

The type of abdominal incision--transverse or vertical--in 291 women with ovarian cancer and completeness of intraoperative evaluation of the extent of disease were investigated. Fourteen percent of woman had transverse incisions, 69% of which were the Pfannenstiel type. Half of the women who had transverse incisions and ovarian cancer were aged 50 years or older. A preoperative diagnosis presumptive of ovarian cancer was made in 93% of women; 71% of the transverse incision group had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. A transverse incision should never be performed in women who are suspected to have ovarian cancer or in women who have ovarian or adnexal tumors and are over 30 years of age.     

梭形横切口在保乳手术中的应用

目的探讨梭形横切口在保乳手术中的应用效果。方法2003年11月~2006年9月对25例乳腺癌患者采用梭形横切口行保乳手术,其中全麻9例,局麻16例。术毕创口置小号引流管,间断缝合残腔,用Prolene线皮下连续埋线法缝合切口。结果术后未发生切口感染、皮下积液及皮肤坏死等并发症,平均7 d出院。随访1~34月,所有病例乳房形态保持良好,患者满意。无一例肿瘤复发。结论梭形横切口为保乳手术提供了一种较好的切口方式。     

经上腹正中切口制作横结肠袢式扭转造口临床分析

目的探讨经上腹正中切口制作横结肠袢式扭转造口的临床效果。方法在上腹正中做一纵切口,使之容纳5个手指,将横结肠提出并逆时针扭转90度,使之与切口方向一致,在横结肠下放置支撑棒,支撑棒两端与皮肤缝合固定。结果该方法可完全转流粪便,无并发症．3～6个月将造口还纳。结论经上腹正中切口行横结肠袢式造口术可避免腹直肌的损伤,符合微创理念。     

直切口与横S形切口对髌骨骨折患者术后瘢痕形成及关节功能的影响比较

目的 比较直切口与横S形切口治疗对髌骨骨折术后瘢痕形成及关节功能的影响。方法 选取 2022年4月-2023年4月我院诊治的70例髌骨骨折患者为研究对象,采用随机数字表法分为对照组和观察 组,各组35例。对照组采用横形切口治疗,观察组采用直切口治疗,比较两组临床手术指标、并发症发 生率、瘢痕VSS评分、关节功能Bostman评分。结果 观察组切口长度小于对照组,术中出血量少于对照 组,骨折愈合时间短于对照组（P ＜0.05）,而两组手术时间比较,差异无统计学意义（P ＞0.05）;观察 组并发症发生率（8.57%）低于对照组（20.00%）（P ＜0.05）;观察组治疗后12周瘢痕各维度（血管分 布、柔软度、色泽、厚度）评分均低于对照组（P ＜0.05）;观察组治疗后12、24周Bostman评分均高于对 照组（P＜0.05）。结论 与横S形切口比较,直切口治疗髌骨骨折具有切口小、术中出血量少、利于骨折愈 合、术后瘢痕形成小、关节功能恢复佳的优势。但横S形切口显露相对较好,临床可依据患者髌骨骨折具 体情况进行合理选择。     

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction

Background

Carotid endarterectomy (CEA) is a very common operation, but there is no agreement on the appropriate orientation of the surgical incision.

Methods

We retrospectively reviewed the charts of patients who had undergone CEA between Jul. 1, 2010, and Dec. 31, 2013. We contacted patients identified in the review to solicit participation in a clinical follow-up examination, during which the esthetic outcome of the scar was evaluated using the Patient and Observer Scar Assessment Scale (POSAS).

Results

During the study period 237 CEAs were performed. Nine patients refused the use of their personal health information in this study. There were no significant differences in the neurologic outcomes of patients based on the incision orientation (perioperative stroke and death 1.4% with transverse incision v. 0% with a vertical incision, p = 0.44). Fifty-two patients presented for follow-up examination. Thirty-three had a transverse incision and 19 had a vertical incision. Results of the POSAS significantly favoured the transverse incision (p = 0.03). Vertical incisions were more often associated with persistent, mild marginal mandibular nerve dysfunction (p = 0.04).

Conclusion

Carotid endarterectomy performed through a transverse skin incision compared with a vertically oriented skin incision is associated with improved esthetic outcome, as measured by the POSAS, without an observed statistically significant difference in the risk of perioperative stroke or death between the 2 techniques.     

不同手术方式治疗小儿腹股沟疝临床疗效

目的比较腹腔镜手术方式、皮横纹下横行小切口术及传统开放手术治疗小儿腹股沟疝临床疗效。 方法回顾性分析2012年1月至2019年1月,湖北省公安县人民医院住院治疗的小儿腹股沟疝396例患者的临床资料,其中行腹腔镜手术治疗124例（A组）、行皮横纹下横行小切口术134例（B组）、行传统开放手术138例（C组）,比较3组患者手术效果及并发症发生情况。 结果3组患儿手术时间、术中出血量、手术切口长度以及住院时间等情况比较,差异有统计学意义（F=1021.469、3426.029、1003.086、945.457,P均<0.001）;组间两两比较,差异均有统计学意义（P<0.05）。3组患儿自主活动时间、术后排气时间以及疼痛评分情况比较,差异均有统计学意义（F=2051.296、519.327、232.345,P均<0.001）;组间两两比较,差异均有统计学意义（P均<0.05）。3组患儿术后并发症总发生率比较,差异有统计学意义（χ²=11.704,P=0.003）;A组和B组并发症发生率均显著低于C组,差异有统计学意义（P<0.05）;而A组与B组并发症发生率比较,差异无统计学意义（P>0.05）。 结论相较于传统开放手术及皮横纹下横行小切口术,腹腔镜手术治疗小儿腹股沟疝具有手术时间短、创伤小,术后恢复快,安全性高等优点,值得临床上进一步推广应用。     

Bilateral single-system ureteroceles with multiple calculi in an adult woman

A 38-year-old woman was seen with a complaint of pollakisuria and constant urinary urgency. Ultrasonography; plain radiography of her kidney, ureter, and bladder; and intravenous urography revealed bilateral ureteroceles with calculi. Bilateral transverse incision of the ureteroceles and lithotripsy were performed using a transurethral approach. At 8 months postoperatively, voiding cystography revealed the absence of vesicoureteral reflux. Although controversies remain about the effectiveness of endoscopic incision because of the risk of vesicoureteral reflux, endoscopic management with a transverse incision is well tolerated for such cases.     

Pediatric postoperative abdominal wound dehiscence: transverse versus vertical incisions

Background: Fascial dehiscence is uncommon in children but can have serious consequences when it occurs. There are multiple risk factors for fascial dehiscence, including the type of incision used. Pediatric surgeons often use a supraumbilical transverse incision particularly in infants because of the access this incision provides to the entire abdomen. This article details the experience with fascial wound dehiscence at a large tertiary children’s hospital and focuses on problems with the types of incision used.

Study Design: This is a retrospective review of 2,785 intraabdominal operations performed over a 5-year period at Children’s Hospital and Regional Medical Center in Seattle. Risk factors for dehiscence were reviewed for each case of fascial dehiscence. Statistical analysis using chi-square was used to examine for differences in complication rates between transverse and vertical incisions.

Results: In this series, 2,442 children (88%) had transverse incisions and 343 (12%) had vertical incisions. Twelve children had abdominal fascial dehiscence postoperatively. Six cases involved transverse incisions and six involved vertical incisions. Five of the children suffered evisceration. One child died as a direct result of the dehiscence. There were multiple risk factors for dehiscence in 10 of the 12 children. Vertical incisions were found to be much more likely to dehisce than were transverse incisions, especially in children under 1 year of age (p < 0.001).

Conclusions: Vertical incisions are more apt to dehisce than transverse incisions in children, particularly babies. We recommend the use of transverse incisions whenever possible in babies less than 1 year of age, especially when other risk factors for dehiscence are present.