Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery

Abstract Background The aim of this study was to examine whether midline, paramedian, or transverse incisions offer potential advantages for abdominal surgery. Data Sources We searched MEDLINE, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials from 1966 to 2009 for randomized controlled trials comparing incision choice. Methods We systematically assessed trials for eligibility and validity and extracted data in duplicate. We pooled data using a random-effects model. Results Twenty-four studies were included. Transverse incisions required less narcotics than midline incisions (weighted mean difference = 23.4 mg morphine; 95% confidence interval [CI], 6.9 to 39.9) and resulted in a smaller change in the forced expiratory volume in 1 second on postoperative day 1 (weighted mean difference = −6.94%; 95% CI, −10.74 to −3.13). Midline incisions resulted in higher hernia rates compared with both transverse incisions (relative risk = 1.77; 95% CI, 1.09 to 2.87) and paramedian incisions (relative risk = 3.41; 95% CI, 1.02 to 11.45). Conclusions Both transverse and paramedian incisions are associated with a lower hernia rate than midline incisions and should be considered when exposure is equivalent.