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A J‐shaped subcostal incision reduces the incidence of abdominal wall complications in liver transplantation
Author(s) -
Heisterkamp Joos,
Marsman Hendrik A.,
Eker Hassan,
Metselaar Herold J.,
Tilanus Hugo W.,
Kazemier Geert
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21594
Subject(s) - medicine , incisional hernia , wound dehiscence , surgery , liver transplantation , dehiscence , abdominal surgery , complication , transplantation , incidence (geometry) , hernia , abdominal wound , ascites , physics , optics
A novel J‐shaped incision for liver transplantation was introduced in attempt to reduce the wound‐related complication rate while maintaining comparable access. Some 58 consecutive patients with the classic Mercedes incision were compared with the following 60 consecutive patients with a J‐shaped incision. Nine of 60 patients (15%) with a J‐shaped incision were converted to an extensive incision. The duration of surgery did not differ between both groups, and relaparotomy rates were comparable in both groups (45% versus 31%, P = 0.487) whereas the early wound‐related morbidity was significantly reduced in the J‐shaped incision group (3% versus 19%, P = 0.009), as well as incisional hernia rate (7% versus 24%, P = 0.002, corrected for different length of follow‐up). Other factors such as previous surgery, ascites, abdominal drainage, retransplantation, and indications for transplantation did not differ between both groups and were not predictive of wound‐related morbidity or incisional hernia. We therefore conclude that a J‐shaped incision should be the incision of choice in liver transplantation. This new, seemingly minor modification reduces wound infections, fascial dehiscence, and incisional hernia. Liver Transpl 14:1655–1658, 2008. © 2008 AASLD.