Skip to main content
SpringerLink
Log in

Effects of abdominal surgery through a midline incision on postoperative trunk flexion strength in patients with colorectal cancer

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Background

Abdominal surgery with bowel resection through a midline or transverse incision is performed in most cases of colorectal cancer (CRC). Both incisions affect abdominal wall function and may lead to differences in postoperative clinical outcomes. Although postoperative isometric trunk flexion strength (ITFS) has previously been investigated, the results were based on measurement tools distinguished by poor reproducibility and validity.

Objective

To evaluate the reproducibility of and variations in ITFS following abdominal surgery using a dynamometer and explore the correlation between ITFS and the scar length.

Method

The study group consisted of 22 consecutive patients (15 men and 7 women) referred for surgery. The outcome parameters included ITFS which was measured using a fixed dynamometer and a digital manometer, scar length, weight and pain. Test–retest measurement (3 h apart) of ITFS was taken 1 day before surgery to determine the instruments’ reproducibility. Additional measurements of the outcome parameters were taken 1 and 6 weeks postoperatively.

Results

Excellent test–retest correlations (ICC > 0.85) coupled with low standard error of the measurement for both the ITFS and the manometric findings indicated clinically acceptable reproducibility of the findings. Significant pre- and postoperative differences in ITFS were noted using both techniques. Six weeks postoperatively, fair and significant correlations were noted between the dynamometry-based ITFS and both the scar length (r = 0.452) and age (r = 0.498). Of note, scar length and preoperative dynamometric ITFS predicted ITFS 6 weeks postoperatively (F = 102.949, p < 0.001, R 2 = 0.92).

Conclusions

Measurements of ITFS using dynamometry in elective CRC patients are reproducible, sensitive to clinical changes and allow prediction of postoperative ITFS scores based on their preoperative counterparts.

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

Fig. 1

Similar content being viewed by others

References

  1. Chassin JL (1994) Operative strategy in general surgery: an expositive atlas, 2nd edn. Springer, New York

    Book  Google Scholar 

  2. Proske JM, Zieren J, MÜller JM (2005) Transverse versus midline incision for upper abdominal surgery. Surg Today 35:117–121

    Article  PubMed  Google Scholar 

  3. Lindgren PG, Nordgren SR, Öreslend T, Hulten L (2001) Midline or transverse abdominal incision for right-sided colon cancer—a randomized trial. Colorectal Dis 3:46–50

    Article  CAS  PubMed  Google Scholar 

  4. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, Buchler MW (2009) Midline versus transverse incision in major abdominal surgery—a randomized, double blind equivalence trial. Ann Surg 249:913–920

    Article  PubMed  Google Scholar 

  5. Siafakas NM, Mitrouska I, Bouros D, Georgopoulos D (1999) Surgery and the respiratory muscles. Thorax 54:458–465

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Watters JM, Clancey SM, Moulton SB, Briere KM, Zhu JM (1993) Impaired recovery of strength in older patients after major abdominal surgery. Ann Surg 218:380–393

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. Halm JA, Lip H, Schmitz PI, Jeekel J (2009) Incisional hernia after upper abdominal surgery: a randomized controlled trial of midline versus transverse incision. Hernia 13:275–280

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, Kuzon WM, Franz MG (2007) Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg 245:140–146

    Article  PubMed Central  PubMed  Google Scholar 

  10. Hollinsky C, Sandberg S (2007) Measurement of tensile strength of the ventral abdominal wall in comparison with scar tissue. Clin Biomech 22:88–92

    Article  CAS  Google Scholar 

  11. Douglas DM (1952) The healing of aponeurotic incisions. Br J Surg 40:79–84

    Article  CAS  PubMed  Google Scholar 

  12. Finni T (2006) Structural and functional features of human muscle-tendon unit. Scand J Med Sci Sports 16:147–158

    Article  CAS  PubMed  Google Scholar 

  13. McConnell AK, Copestake AJ (1999) Maximum static respiratory pressures in healthy elderly men and women: issues of reproducibility and interpretation. Respiration 66:251–258

    Article  CAS  PubMed  Google Scholar 

  14. Enright PL, Kronmal RA, Manolio TA, Schenker MB, Hyatt RE (1994) Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular health study research group. Am J Respir Crit Care Med 149:430–438

    Article  CAS  PubMed  Google Scholar 

  15. Smeltzer SC, Lavietes MH (1999) Reliability of maximal respiratory pressures in multiple sclerosis. Chest 115:1546–1552

    Article  CAS  PubMed  Google Scholar 

  16. Man WDC, Kyroussis D, Fleming TA, Chetta A, Harraf F, Mustfa N, Rafferty GF, Polkey MI, Moxham J (2003) Cough gastric pressure and maximum expiratory mouth pressure in humans. Am J Respir Crit Care Med 168:714–717

    Article  PubMed  Google Scholar 

  17. Dvir Z (2004) Isokinetics: muscle testing, interpretation and clinical applications, 2nd edn. Elsevier-Churchill Livingstone, Edinburgh

    Google Scholar 

  18. Moreland J, Finch E, Stratford P, Balsor B, Gill C (1997) Interrater reliability of six tests of trunk muscle function and endurance. JOSPT 26:200–208

    Article  CAS  PubMed  Google Scholar 

  19. Shrier I, Feldman D, Klvana J, Rossingnol M, Abenhaim L (2003) Comparison between tests of fatigue and force for trunk flexion. Spine 28:1373–1378

    PubMed  Google Scholar 

  20. Helewa A, Goldsmith CH, Smythe HA (1993) Measuring abdominal muscle weakness in patients with low back pain and matched controls: a comparison of 3 devices. J Rheumatol 20:1539–1542

    CAS  PubMed  Google Scholar 

  21. Ladeira CE, Hess LW, Galin BM, Fradera S, Harkness MA (2005) Validation of an abdominal muscle strength test with dynamometry. J Strength Cond Res 19:925–930

    PubMed  Google Scholar 

  22. den Hartog D, Elker HH, Tuinebreijer WE, Kleinrensink GJ, Stam HJ, Lange JF (2010) Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia 14:243–247

    Article  Google Scholar 

  23. Amundsen LR (1990) Muscle strength testing: instrumented and non-instrumented systems. Churchill Livingstone, Edinburgh

    Google Scholar 

  24. Bohannon RW (1990) Hand-held compared with isokinetic dynamometry for measurement of static knee extension torque (parallel reliability of dynamometers). Clin Phys Physiol Meas 11:217–222

    Article  CAS  PubMed  Google Scholar 

  25. Kolber MJ, Cleland JA (2005) Strength testing using hand-held dynamometry. Phys Ther Rev 10:99–112

    Article  Google Scholar 

  26. Wang CY, Olson SL, Protas EJ (2002) Test-retest strength reliability: hand-held dynamometry in community-dwelling elderly fallers. Arch Phys Med Rehabil 83:811–815

    Article  PubMed  Google Scholar 

  27. Brinkmann JR (1994) Comparison of a hand-held and fixed dynamometer in measuring strength of patients with neuromuscular disease. J Orthop Sports Phys Ther 19:100–104

    Article  CAS  PubMed  Google Scholar 

  28. American Thoracic Society/European Respiratory Society (2002) ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–624

    Article  Google Scholar 

  29. De Torres JP, Talamo C, Aguirre-Jaime A, Rassulo J, Celli B (2003) Electromyographic validation of the mouth pressure-time index: a noninvasive assessment of inspiratory muscle load. Respir Med 97:1006–1013

    Article  PubMed  Google Scholar 

  30. Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek AL (2001) Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res 10:571–578

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel

    I. Paiuk & Z. Dvir

  2. Department of Surgery A, Assaf Harofeh Medical Center, Zriffin, Israel

    I. Paiuk & I. Wasserman

Authors
  1. I. Paiuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Wasserman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Z. Dvir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z. Dvir.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paiuk, I., Wasserman, I. & Dvir, Z. Effects of abdominal surgery through a midline incision on postoperative trunk flexion strength in patients with colorectal cancer. Hernia 18, 487–493 (2014). https://doi.org/10.1007/s10029-012-1027-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-012-1027-x

Keywords

Search

Navigation