Patient recovery following cholecystectomy through a 6 cm or 15 cm transverse subcostal incision: a prospective randomized clinical trial

Abstract

Summary:The effect of incision length on patient recovery following cholecystectomy has not been investigated previously. In this study, 30 patients with symptomatic gallstones were randomized to cholecystectomy through a 6 cm or 15 cm transverse subcostal incision. Postoperative hospital stay was significantly shorter in the 6 cm incision group (median 3 days vs 5 days; P = 0.0069 Mann-Whitney U-test). In the 6 cm group analgesic requirements were reduced (median 2.5 vs 4.5 intramuscular opiate injections per patient) and recovery of depressed postoperative pulmonary function (FVC and FEV1) was faster (3% difference between groups on day 1 and 7% on day 3), although these differences did not achieve statistical significance. These results suggest that the length of incision may influence patient recovery following elective cholecystectomy. This has important implications as surgery carried out through shorter and less traumatic incisions may offer a cost-effective alternative to laparoscopic cholecystectomy. Moreover, some surgeons may find mini-laparotomy cholecystectomy easier to adopt than laparoscopic techniques.

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations

“…Instead of open conventional cholecystectomy "minicholecystectomy" may be used (12,20) and there are papers indicating that hospital stay was shorter after minicholecystectomy, whereas operating times did not differ from those of open conventional cholecystectomy (1,2,35). In only one investigation was there no signi cant intergroup difference in hospital stay, which was extremely high values (11 days) in both groups (41).…”

Midline or transverse abdominal incision for right‐sided colon cancer—a randomized trial

“…It is also possible that a transverse incision may permit a more anatomical dissection of the right colonic flexure. The lengths of the two types of incision were equal, length being another factor with implications for pain [13]. Depending on need, the transverse incision may pass through one or both anterior rectus muscles.…”

Non-randomised patients in a cholecystectomy trial: characteristics, procedures, and outcomes

“…Under these circumstances, the high percentage of open cholecystectomy among our non-randomised patients is not surprising. Nevertheless, the number of conventional open cholecystectomy compared to mini-laparotomy cholecystectomy is a matter of concern, as randomised controlled trials [11-13] have concluded that the surgical trauma is greater after conventional open cholecystectomy than after mini-laparotomy cholecystectomy.…”