Midline and paramedian incisions in the elective and urgent laparotomies: comparative study

ABSTRACT

The lateral paramedian incision has been devocated as the strongest incision for abdominal surgery. We have evaluated this incision and compared it with midline incision without closure of the deep peritoneal layer. All 206 patients undergoing laparotomy in the surgical unit from 1988-1990 both elective and emergency cases, were included. In patients undergoing laparotomy through unscarred tissue, a lateral paramedian incision was performed and they were randomize to have either the paramedian incision [n=77] or midline incision [n=78]. Patients in whom the laparotomy was performed through a previous incision [n=51] were excluded from the trial. The rectus sheath was closed with monofilament nylon in all cases. Patients were assessed for wound integrity during the immediate postoperative period and at 1, 3,6 and 12 months after operation. There have been no cases of burst abdomen in paramedian incision while two cases [2.6%] occurred in midline incision. One case [1%] of incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed, seven [9%] incisional hernias have occurred in patients underwent midline incision. We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare. While these complications were significantly larger in midline incisions