Transverse versus vertical skin incision for planned cesarean hysterectomy: does it matter?

Abstract

Background To investigate differences in perioperative outcomes by type of skin incision, transverse versus vertical, for planned cesarean hysterectomy for placenta accreta spectrum (PAS). Methods A retrospective cohort study of all women who underwent a planned cesarean hysterectomy for abnormal placentation at a single academic medical center over 5 years. The Student’s t-test was used for continuous variables and Fisher’s exact test compared categorical variables. Continuous data were presented as median and compared using the Wilcoxon-rank sum test. Results Forty-two planned cesarean hysterectomies were identified. A transverse skin incision was made in 43% (n = 18); a vertical skin incision was made in 57% (n = 24). Skin incision was independent of BMI (30.3 vs 30.8 kg/m2, p = 0.37), placental location (p = 0.82), and PAS-subtype (p = 0.26). Mean estimated blood loss (EBL) was 2.73 l (L) (range 0.5–20) and was not significantly different between transverse and vertical skin incision (2.6 L vs 2.8 L, p = 0.8). There was significantly shorter operative time with transverse skin incision (180 vs 238 min, p = 0.03), with no difference in intraoperative complications, including cystotomy (p = 0.22) and ureteral injury (p = 0.73). Postoperatively, there was no difference in maternal length of stay (4.8 vs 4.4 days, p = 0.74) or post-operative opioid use (117 vs 180 morphine equivalents, p = 0.31). Conclusion Transverse skin incision is associated with shorter operative time for patients undergoing planned cesarean hysterectomy. There was no difference in EBL, intraoperative complications, postoperative length of stay, or opioid use. Given an increasing rate of cesarean hysterectomy, we should consider variables that optimize maternal outcomes and resource utilization.

Outcome of 17 patients undergoing Cesarean Hysterectomy by Cherney Incision for Placenta Accreta Spectrum: A CaseSeries

“…One of the most common complications of cesarean hysterectomy is a postpartum hemorrhage. In the literature, the median estimated blood loss has been reported to be between 2.5 to 7.8 liters [13][14][15][16]. There have been numerous studies and national efforts with the goal of decreasing maternal morbidity for PAS, speci cally blood loss and blood transfusions.…”

“…In terms of cesarean hysterectomy for PAS, most guidelines recommend that the incision type can be decided by the surgical team [16]. There is one published study examining transverse vs vertical incision, demonstrating non-inferiority between the skin incision types [15]. The only signi cant nding was a difference in mean operative time with transverse skin incisions being on average 60 minutes shorter than for vertical incision.This article did not speci cally mention cherney incisions or explore the outcomes associated with this type of incision.…”

“…While there is no evidence to suggest that a vertical incision is superior to a transverse incision in patients undergoing cesarean hysterectomy for PAS [8][9], there are proven cosmetic and healing advantages for transverse incisions [10]. As an alternative, our group recommends a cherney incision for patients with PAS undergoing a cesarean hysterectomy.…”

Surgical Techniques for the Management of Placenta Accreta Spectrum

“…A retrospective cross-sectional comparison of transverse (Pfannenstiel) versus vertical skin incision for planned cesarean hysterectomy for PAS did not uncover any differences in several outcome variables. 19 However, the study had significant limitations related to the number of patients included, the absence of description of the approach used for the uterine incision when a transverse skin incision was used, and the lack of pathologic confirmation of the presence and severity of the PAS.…”