Skip to main content

Advertisement

SpringerLink
Log in

Optimal Abdominal Incision for Partial Hepatectomy: Increased Late Complications with Mercedes-type Incisions Compared to Extended Right Subcostal Incisions

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

The optimal abdominal incision for partial hepatectomy has not been established.

Methods

A prospective hepatobiliary surgery database was retrospective reviewed. Patients with Mercedes and extended right subcostal (ERSC) incisions were identified and compared.

Results

Between December 1991 and September 2001 a total of 1426 patients met the inclusion criteria. Among them, 856 (60%) had a Mercedes incision and 570 (40%) an ERSC incision. The two groups were well matched for demographics and operative variables. Perioperative morbidity and pulmonary complications were similar for the two groups as well. There was no difference in terms of early wound complications, although incisional hernias occurred in 9.8% of patients with a Mercedes incision compared to 4.8% of those with an ERSC incision (P = 0.0001.) On multivariate analysis, the incision type, along with gender, body mass index, and age, were significant predictors of incisional hernia.

Conclusions

An ERSC incision for partial hepatectomy provides adequate, safe access and is associated with fewer long-term wound complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730

    Article  CAS  PubMed  Google Scholar 

  2. Lin KY, Johns FR, Gibson J, et al. An outcome study of breast reconstructions: presurgical identification of risk factors for complications. Ann Surg Oncol 2001;8:586–591

    CAS  PubMed  Google Scholar 

  3. Leaper DJ, Melling AG. Antibiotic prophylaxis in clean surgery: clean non-implant wounds. J Chemother 2001;13:96–101

    PubMed  Google Scholar 

  4. Nicolle LE, Huchcroft SA, Cruse PJ. Risk factors for surgical wound infection among the elderly. J Clin Epidemiol 1992;45:357–364

    Article  CAS  PubMed  Google Scholar 

  5. Kahan BD. Nutrition and host defense mechanisms. Surg Clin North Am 1981;61:557–570

    CAS  PubMed  Google Scholar 

  6. Malone DL, Genuit T, Tracy JK, et al. Surgical site infections: reanalysis of risk factors. J Surg Res 2002;103:89–95

    Article  PubMed  Google Scholar 

  7. Meakins JL, Christou NV, Halle CC, et al. Influence of cancer on host defense and susceptibility to infection. Surg Forum 1979;30:115–117

    CAS  PubMed  Google Scholar 

  8. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278

    Article  CAS  PubMed  Google Scholar 

  9. Halasz NA. Vertical vs horizontal laparotomies. I. Early postoperative comparisons. Arch Surg 1964;88:911–914

    CAS  PubMed  Google Scholar 

  10. Armstrong PJ, Burgess RW. Choice of incision and pain following gallbladder surgery. Br J Surg 1990;77:746–748

    CAS  PubMed  Google Scholar 

  11. Garcia-Valdecasas JC, Almenara R, Cabrer C, et al. Subcostal incision versus midline laparotomy in gallstone surgery: a prospective and randomized trial. Br J Surg 1988;75:473–475

    CAS  PubMed  Google Scholar 

  12. Becquemin JP, Piquet J, Becquemin MH, et al. Pulmonary function after transverse or midline incision in patients with obstructive pulmonary disease. Intensive Care Med 1985;11:247–251

    Article  CAS  PubMed  Google Scholar 

  13. Elman A, Langonnet F, Dixsaut G, et al. Respiratory function is impaired less by transverse than by median vertical supraumbilical incisons. Intensive Care Med 1981;7:235–239

    Article  CAS  PubMed  Google Scholar 

  14. Massucci M, Lauri D, Faraglia V, et al. Approach to the abdominal aorta: impairment of respiratory function after supraumbilical transverse and midline laparotomy. Ital J Surg Sci 1989;19:247–253

    CAS  PubMed  Google Scholar 

  15. Stone HH, Hoefling SJ, Strom PR, et al. Abdominal incisions: transverse vs vertical placement and continuous vs interrupted closure. South Med J 1983;76:1106–1108

    CAS  PubMed  Google Scholar 

  16. Grantcharov TP, Rosenberg J. Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 2001;167:260–267

    CAS  PubMed  Google Scholar 

  17. Blomstedt B, Welin-Berger T. Incisional hernias: a comparison between midline, oblique and transrectal incisions. Acta Chir Scand 1972;138:275–278

    CAS  PubMed  Google Scholar 

  18. Xia F, Poon RT, Fan ST, et al. Thoracoabdominal approach for right-sided hepatic resection for hepatocellular carcinoma. J Am Coll Surg 2003;196:418–427

    Article  PubMed  Google Scholar 

  19. Tsugita M, Takasake K, Ohtsubo T, et al. Right side hepatic resection under right thoracoabdominal incision with special reference to a highly anatomical systematized method. Int Surg 1995;80:242–246

    CAS  PubMed  Google Scholar 

  20. Sato H, Sugawara Y, Yamasaki S, et al. Thoracoabdominal approaches versus inverted T incision for posterior segmentectomy in hepatocellular carcinoma. Hepatogastroenterology 2000;47:504–506

    CAS  PubMed  Google Scholar 

  21. Kise Y, Takayama T, Yamamoto J, et al. Comparison between thoracoabdominal and abdominal approaches in occurrence of pleural effusion after liver cancer surgery. Hepatogastroenterology 1997;44:1397–1400

    CAS  PubMed  Google Scholar 

  22. Savage AP, Malt RA. Elective and emergency hepatic resection: determinants of operative mortality and morbidity. Ann Surg 1991;214:189–196

    Google Scholar 

  23. Stimpson RE, Pellegrini CA, Way LW. Factors affecting the morbidity of elective liver resection. Am J Surg 1987;153:189–196

    Article  CAS  PubMed  Google Scholar 

  24. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236:397–406

    Article  PubMed  Google Scholar 

  25. Couinaud C. Le Foie: Etudes anatomiques et Chirurgicales. Masson & Cie, Paris 1957

    Google Scholar 

  26. Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection. Ann Surg 2004;239:599–607

    PubMed  Google Scholar 

  27. Greenall MJ, Evans M, Pollock AV. Midline or transverse laparotomy? A random controlled clinical trial. Part I. Influence on healing. Br J Surg 1980;67:188–190

    CAS  PubMed  Google Scholar 

  28. Greenall MJ, Evans M, Pollock AV. Midline or transverse laparotomy? A random controlled clinical trial. Part II. Influence on postoperative pulmonary complications. Br J Surg 1980;67:191–194

    CAS  PubMed  Google Scholar 

  29. Williams CD, Brenowitz JB. Ventilatory patterns after vertical and transverse upper abdominal incisions. Am J Surg 1975;130:725–728

    Article  CAS  PubMed  Google Scholar 

  30. Inaba T, Okinaga K, Fukushima R, et al. Prospective randomized study of two laparotomy incisions for gastrectomy: midline incision versus transverse incision. Gastric Cancer 2004;7:167–171

    Article  PubMed  Google Scholar 

  31. Elman A, Langonnet F, Dixsaut G, et al. Respiratory function is impaired less by transverse than by vertical supraumbilical incisions. Intensive Care Med 1981;7:235–239

    Article  CAS  PubMed  Google Scholar 

  32. Yu YQ, Tang ZY, Ma ZC, et al. Resection of segment VIII of liver for treatment of primary liver cancer. Arch Surg 1993;128:224–227

    CAS  PubMed  Google Scholar 

  33. Ryan WH, Hummel BW, McClelland RN. Reduction in the morbidity and mortality of major hepatic resection: experience with 52 patients. Am J Surg 1982;144:740–743

    CAS  PubMed  Google Scholar 

  34. Lord RS, Crozier JA, Snell J, et al. Transverse abdominal incisions compared with midline incisions for elective infrarenal aortic reconstruction: predisposition to incisional hernia in patients with increased intraoperative blood loss. J Vasc Surg 1994;20:27–33

    CAS  PubMed  Google Scholar 

  35. De Silva AL, Petroianu A. Incisional hernias: factors influencing development. South Med J 1991;84:1500–1504

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA

    Michael D’Angelica MD, Sridevi Maddineni MD, Yuman Fong MD, Robert C.G. Martin MD, Michael S. Cohen MD, Ronald P. DeMatteo MD, Leslie H. Blumgart MD & William R. Jarnagin MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA

    Leah Ben-Porat MS & Mithat Gonen PhD

Authors
  1. Michael D’Angelica MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sridevi Maddineni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuman Fong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert C.G. Martin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael S. Cohen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leah Ben-Porat MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mithat Gonen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ronald P. DeMatteo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Leslie H. Blumgart MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. William R. Jarnagin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William R. Jarnagin MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

D’Angelica, M., Maddineni, S., Fong, Y. et al. Optimal Abdominal Incision for Partial Hepatectomy: Increased Late Complications with Mercedes-type Incisions Compared to Extended Right Subcostal Incisions. World J. Surg. 30, 410–418 (2006). https://doi.org/10.1007/s00268-005-0183-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0183-x

Keywords

Search

Navigation