Which Incision Type for Abdominal Surgery?

Abdominal surgery isn’t fun. Often minimally invasive “keyhole” surgery is performed, but some patients don’t get off that easy.

For abdominal surgeries involving large incisions, the surgeon decides whether to make a midline (vertical) or transverse (horizontal) incision. When I had a laparotomy (that’s a major abdominal surgery with an incision of around four or five inches), the surgeon recommended a transverse incision because I could “still wear a bikini.” I’ll tell you how that went in a bit. First, a new study compared the two incision types.

The Department of Surgery at Heidelberg University Hospital studied transverse and midline incisions used in abdominal surgery. The study was published in the Annals of Surgery. Here’s the really interesting thing: The study was blind! Patients received a very large dressing (shown in photo) and had no idea whether the incision was horizontal or vertical. Physicians and nursing staff  were also kept in the dark. This was done so that the pain levels could be accurately obtained. Of course, the surgeon knew the incision type, but the surgeons weren’t involved with gathering data for the study.

Study findings: There was no difference in healing process or post-surgical pain among the two incision types. The complication rate was the same with the exception of wound infection, which was higher for transverse incisions. Researchers concluded that there’s a “scientific basis for allowing the surgeon the free choice of incision technique.”

As for me, I may never know if the incision type caused the extreme post-surgical pain and complication of incisional hernia I experienced. However, if I had it to do over, I’d go with the other incision type (midline) just to see if it turned out better. I don’t wear bikinis anyway. . .

(Image via Heidelberg University Hospital) Sorry for the manly photo in the women’s health section! However, it is from the study.