A Comparison of Mini Open Transverse Incision and Longitudinal Incision for the Release of Moderate and Severe Carpal Tunnel Syndrome.

OBJECTIVES: Carpal tunnel syndrome is a common condition seen in daily clinical practice. Multiple minimally invasive techniques have emerged in the last decades for median nerve decompression. However, many research are needed to study the outcome on the patients and their safety profile. METHODS: We will compare group A that includes patients operated on using the minimally invasive transverse incision (number of patients = n = 221, females 76.7% and males 22.8%) versus group B that includes patients operated on using the longitudinal incision (n = 194, female 70.1% and male 29.9%) in term of clinical satisfaction and safety. The mean age of group A is 58.1±5.1 and that of group B is 58.8±4.8. The male and female distribution in both groups and the mean age were both similar with no statistically significant difference for the age (p = 0.79) or the gender distribution (p = 0.1). Data collected prospectively at regular intervals in time (preoperatively and at one month, three months, and six months post-carpal tunnel release (CTR)) between January 2006 and December 2021 were reviewed retrospectively. Patients' clinical findings, grip strength measurement using a hand dynamometer, and postoperative satisfaction measured using the BCTQ (Boston Carpal Tunnel Syndrome Questionnaire) scoring system were recorded and analyzed for each technique. RESULTS: A total of 415 patients were included in our study. All patients included had moderate to severe median nerve compression documented by nerve-conducted studies with positive Tinel's and Phalen's signs. Baseline demographics between group A (CTR through a longitudinal palmar mini-incision) and group B (CTR with a mini-transverse incision at the palmar crease) didn't show a statistically significant difference. Both groups showed improved grip strength and BCTQ scores at the post-operative follow-up. CONCLUSIONS: Median nerve decompression using both types of incisions has resulted in the same functional outcomes and patient satisfaction.

The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations.

AIM: To analyze laparotomy closure quality (suture/wound length ratio; SL/WL) and short term complications (surgical site occurrence; SSO) of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. METHOD: Prospective, monocentric, non-randomized, controlled cohort study on short stitches with a longterm resorbable, elastic suture (poly-4-hydroxybutyrate, [p-4OHB]) aiming at a 6:1 SL/WL-ratio in midline and transverse, primary and secondary laparotomies for elective and emergency surgeries. RESULTS: We included 351 patients (♂: 208; ♀: 143) with midline (n = 194), transverse (n = 103), and a combined midline/transverse L-shaped (n = 54) incisions. There was no quality difference in short stitches between elective (n = 296) and emergency (n = 55) operations. Average SL/WL-ratio was significantly higher for midline than transverse incisions (6.62 ± 2.5 vs 4.3 ± 1.51, p < 0.001). Results in the first 150 patients showed a reduced SL/WL-ratio to the following 200 suture closures (SL/WL-ratio: 5.64 ± 2.5 vs 6.1 ± 2.3; p < 0.001). SL/WL-ratio varied insignificantly among the six surgeons participating while results were steadily improving over time. Clinically, superficial surgical site infections (SSI, CDC-A1/2) were encountered in 8%, while 4,3% were related to intraabdominal complications (CDC-A3). An abdominal wall dehiscence (AWD) occurred in 22/351 patients (6,3%)-twice as common in emergency than elective surgery (12,7 vs 5,1%)-necessitating an abdominal revision in 86,3% of cases. CONCLUSION: We could show that a short stitch 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be performed in only 43% of cases (85% > 4:1 SL/WL-ratio), significantly better in midline than transverse incisions. Transverse incisions should preferably be closed in two layers to achieve a sufficient SL/WL-ratio equivalent to the median incision. GOV IDENTIFIER: NCT01938222.

Clinical Outcomes in Dogs Undergoing Cholecystectomy via a Transverse Incision: A Meta-Analysis of 121 Animals Treated between 2011 and 2021.

Although many studies have been conducted on the use of median and transverse incisions in various surgeries in the field of human medicine, related studies in veterinary medicine are lacking. This study aimed to present treatment options for dogs requiring cholecystectomy by reporting the pros and cons of 121 cholecystectomies performed via transverse incision at our hospital over 10 years. In most included cases, nonelective cholecystectomy was performed in an unstable emergency situation. The perioperative mortality rate was 23.14%, which was not significantly different from that of cholecystectomy performed via the conventional midline approach. However, the overall operation time (46.24 ± 6.13 min; range 35-65 min) was shortened by securing an adequate surgical field of view. The transverse incision approach facilitates fast and accurate surgery without increasing the fatality rate in small-breed dogs, in whom securing an adequate surgical field of view is difficult. Thus, transverse incision should be actively considered in dogs undergoing cholecystectomy due to emergency conditions, such as bile leakage or biliary tract obstruction, since prolonged anesthesia can be burdensome. This study may improve cholecystectomy outcomes in small-breed dogs with difficult-to-secure surgical fields.

Systematic review with meta-analysis of transverse vs. vertical midline extraction incisional hernia risk following laparoscopic colorectal resections.

Background: The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision. Methods: Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software. Results: Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau2=0.97; Chi2=109.98, df=24, P=0.00004; I2=78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence. Conclusions: Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.

Transverse Incision for Pancreatoduodenectomy Reduces Wound Complications: A Single-Center Analysis of 399 Patients.

BACKGROUND: Even if the minimally invasive approach is advancing in pancreatic surgery, the open approach is still the standard for a pancreatoduodenectomy. There are two types of incisions used: the midline incision (MI) and transverse incision (TI). The aim of this study was to compare these two incision types, especially regarding wound complications. METHODS: A retrospective review of 399 patients who underwent a pancreatoduodenectomy at the University Hospital Erlangen between 2012 and 2021 was performed. A total of 169 patients with MIs were compared with 230 patients with TIs, with a focus on postoperative fascial dehiscence, postoperative superficial surgical site infection (SSSI) and the occurrence of incisional hernias during follow-up. RESULTS: Postoperative fascial dehiscence, postoperative SSSI and incisional hernias occurred in 3%, 8% and 5% of patients, respectively. Postoperative SSSI and incisional hernias were significantly less frequent in the TI group (SSI: 5% vs. 12%, p = 0.024; incisional hernia: 2% vs. 8%, p = 0.041). A multivariate analysis confirmed the TI type as an independent protective factor for the occurrence of SSSI and incisional hernias (HR 0.45 (95% CI = 0.20-0.99), p = 0.046 and HR 0.18 (95% CI = 0.04-0.92), p = 0.039, respectively). CONCLUSION: Our data suggest that the transverse incision for pancreatoduodenectomy is associated with reduced wound complications. This finding should be confirmed by a randomized controlled trial.

Minimally Invasive Carpal Tunnel Release Using a Hook Knife through a Small Transverse Carpal Incision: Technique and Outcome.

Background: Compared to the classic open technique, limited exposure techniques have the advantages of less scar pain, more grip and pinch strength, and earlier return to daily life. We evaluated the effectiveness and safety of our novel method of minimally invasive carpal tunnel release using a hook knife through a small transverse carpal incision. Methods: This study included 111 carpal tunnel decompressions in 78 patients who underwent carpal tunnel release from January 2017 to December 2018. We performed carpal tunnel release using a hook knife through a small transverse incision just proximal to the wrist crease under local infiltration of lidocaine with tourniquet inflation in the upper arm. All patients were tolerable during the procedure and discharged following the procedure on the same day. Results: At an average of 29.4 months of follow-up (range, 12-51 months), all but one patient (99%) revealed complete or near complete symptomatic recovery. The average of the symptom severity score on the Boston questionnaire was 1.31 ± 0.30 and the average of the functional status score was 1.19 ± 0.26. The final mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) score was 8.66 (range, 2-39). There was no superficial palmar arch injury or nerve injury of the palmar cutaneous branch, recurrent motor branch, or median nerve itself as a complication of the procedure. No patient showed any wound infection or wound dehiscence. Conclusions: Our carpal tunnel release using a hook knife through a small transverse carpal incision performed by an experienced surgeon is a safe and reliable method that is expected to have the benefits of simplicity and minimal invasiveness.

Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review.

Cesarean section via a transverse uterine fundal incision is performed in patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant woman who previously underwent a cesarean section and recovered from cardiac arrest by multidisciplinary management.

Transverse incision versus longitudinal incision in the implantation of PICC-port: A before-after study.

BACKGROUND: The peripherally inserted central catheter-port (PICC-port) technique is an innovation of the standard arm-totally implantable vascular access device. The design of surgical skin incision may have an important impact on the postoperative life of patients, the cosmetic result is important for patient satisfaction as well. OBJECTIVES: To compare two different incision methods in the implantation of PICC-port. DESIGN: A before-after study. SETTINGS AND PARTICIPANTS: A total of 62 adult patients with malignant tumor requiring chemotherapy in Shanghai General Hospital were selected by convenience sampling, 31 in each group. All participants agreed to install PICC-port with signature from 1 Jan to 30 April, 2022. METHODS: 31 patients were given longitudinal incision, about 3 cm below the puncture point obliquely. Another 31 patients were given transverse incision, about 3 cm below the puncture point. T-test, chi-square test and rank sum test were used to compare the differences between the two groups in incision healing, scar score, and operation time. RESULTS: There was no statistically significant difference in incision healing between the two groups(p > 0.05). The scar scores of patients with transverse incision were higher than that of patients with longitudinal incision at 3 months (p < 0.05). And the operation time of longitudinal incision group was longer than that of transverse incision group(p < 0.05). CONCLUSIONS: Our study revealed that PICC-port implantation could be considered as safe as PICC insertion conducted by nurse. During our follow-up, all patients with PICC-port implantation had good wound healing, and there were no complications such as local infection happened. The transverse incision was more easier to be operated in bag making in PICC-port implantation.

Is There Another Posterior Approach for Presacral Tumors Besides the Kraske Procedure? - A Study on the Feasibility and Safety of Surgical Resection of Primary Presacral Tumors via Transsacrococcygeal Transverse Incision.

Background: The aim of the present study was to explore the feasibility and safety of the surgical resection of presacral tumors via a transsacrococcygeal transverse incision. Methods: The clinical data and prognoses of patients with presacral tumors who underwent surgery at the Chinese People's Liberation Army (PLA) General Hospital between January 2009 and December 2018 were retrospectively reviewed and analyzed. Results: A total of 110 patients with presacral tumors were included in this study, including 82 female patients and 28 male patients, with a female-to-male ratio of 2.9:1. A posterior approach (transsacrococcygeal transverse incision) was utilized in 105 patients, an anterior approach (transabdominal excision) was utilized in 1 patient, and a combined (posterior plus anterior) approach was utilized in 4 patients. The mean tumor size was 8.72 ± 4.28 cm. More than half of the patients (n=59/110) with presacral tumors were asymptomatic. Twenty-six pathological types were observed in our study, including 97 benign lesions and 13 malignant lesions. The intraoperative complication rate was 42.7% (n=47/110), whereas the postoperative morbidity rate was 3.6% (n=4/110). The length of hospital stay for patients treated with the posterior approach was shorter than that of patients treated with the anterior and combined approaches. After a mean follow-up of 90.13 ± 31.22 months, 11 patients had local presacral tumor recurrence, and 1 patient had distant metastasis, with a combined recurrence rate of 10.9% (n=12/110). Conclusions: The surgical resection of primary presacral tumors via a transsacrococcygeal transverse incision is feasible and safe, with acceptable oncological therapeutic outcomes and a low postoperative morbidity rate, making it worth popularizing in clinical practice.

What Type of Incision for Anterior Cervical Spine Surgery Involving Long Segments Can Bring Better Cosmetic and Functional Outcomes?

OBJECTIVE: To determine whether double transverse incisions could provide superior cosmetic and functional outcomes, including rates of dysphagia and dysphonia, compared with longitudinal incisions in patients undergoing anterior cervical spine surgery (ACSS) involving ≥ 3 levels. METHODS: A total of 62 consecutive patients who underwent ACSS involving ≥ 3 levels were included in this study. They consist of 33 with longitudinal incisions (L group) and 29 with double transverse incisions (DT group). We recorded functional outcome measures including the Bazaz score for postoperative dysphagia and the Voice Handicap Index-10 (VHI-10) for postoperative dysphonia. The Vancouver Scar Scale (VSS) and the patient and observer scar assessment scale (POSAS) were used to evaluate postoperative skin scarring. RESULTS: Cosmetic results, as assessed using the VSS and POSAS, were significantly better in the DT than in the L group at most follow-up time points (p < 0.01 each). Dysphagia rates were significantly lower in the DT group than in the L group during the late postoperative period from 6 months until final 2 years of follow-up (p < 0.01 each). There were no significant different results between the 2 groups in terms of dysphonia. CONCLUSION: A double transverse incision can be a feasible option when performing ACSS involving ≥ 3 levels, providing better cosmesis and lower rates of persistent dysphagia than with a longitudinal incision.

Effectiveness and safety of surgical treatment of carpal tunnel syndrome via a mini-transverse incision and a bush hook versus a mid-palmar small longitudinal incision.

BACKGROUND: Minimally invasive surgery for carpal tunnel syndrome has been consistently the mainstay of treatment. In this study, we developed a novel bush hook via a mini-transverse incision at proximal wrist crease to surgically treat carpal tunnel syndrome and our aim was to compare the results with those of mid-palmar small longitudinal incision in carpal tunnel release. METHODS: This is a retrospective study on patients who received a mini-transverse incision and a novel bush hook or a mid-palmar small longitudinal incision for treatment of carpal tunnel syndrome. The decision to receive either technique was made mainly based on patients' choice. The clinical results were evaluated at 1 week, 1 month, 3 and 6 months postoperatively and compared. RESULTS: In total, 58 patients in mini-transverse incision group and 74 in mid-palmar longitudinal incision group were include. The follow-up period was 6.8 ± 1.6 months. The mini-transverse incision group had a significantly smaller incision (4.3 ± 0.4 mm vs. 26.2 ± 1.6 mm), shorter surgical time (7.8 ± 2.6 min vs. 19.7 ± 2.8 min), but not for hospital stay (3.2 ± 1.9 vs. 3.6 ± 2.2 days). Both groups showed significant improvement from baseline level at any time points postoperatively (all P < 0.001). At 1 month and 3 months, the mini-transverse incision group showed a significantly better improvement of VAS, SSS and FSS score (P < 0.05). At 6 months, the differences were no longer significant (P > 0.05). In addition, the mini-transverse incision group showed a significantly reduced time to return to the work and activities, tendency to higher rate of excellence and good outcomes and fewer complications. CONCLUSIONS: This novel technique via a mini-transverse incision and bush hook showed better clinical effectiveness and safety, and can be considered as an alternative for wrist tunnel release after the results are validated by higher-level evidence studies. Evidence level: III.

The transverse-vertical incision (Alazzam hybrid incision).

Open abdominal surgery evolved around two incisions, vertical and transverse incisions. Transverse incisions are associated with less postoperative morbidities but offer limited access. Vertical incisions offer better access but are associated with more complications. We describe here a hybrid incision, transverse-vertical incision that offers adequate exposure for complex lower abdominopelvic surgery while overcoming the limitations and morbidities associated with midline and transverse incisions.

Midline incision vs. transverse incision for specimen extraction is not a significant risk factor for developing incisional hernia after minimally invasive colorectal surgery: multivariable analysis of a large cohort from a single tertiary center in Korea.

BACKGROUND: Incisional hernia (IH) is a commonly encountered problem even in the era of minimally invasive surgery (MIS). Numerous studies on IH are available in English literature, but there are lack of data from the Eastern part of the world. This study aimed to evaluate the risk factors as well as incidence of IH by analyzing a large cohort collected from a single tertiary center in Korea. METHODS: Among a total number of 4276 colorectal cancer patients who underwent a surgical resection from 2006 to 2019 in Korea University Anam Hospital, 2704 patients (2200 laparoscopic and 504 robotic) who met the inclusion criteria were analyzed. IH was confirmed by each patient's diagnosis code registered in the hospital databank based on physical examination and/or computed tomography findings. Clinical data including specimen extraction incision (transverse or vertical midline) were compared between IH group and no IH group. Risk factors of developing IH were assessed by utilizing univariable and multivariable analyses. RESULTS: During the median follow-up of 41 months, 73 patients (2.7%) developed IH. Midline incision group (n = 1472) had a higher incidence of IH than that of transverse incision group (n = 1232) (3.5% vs. 1.7%, p = 0.003). The univariable analysis revealed that the risk factors of developing IH were old age, female gender, obesity, co-morbid cardiovascular disease, transverse incision for specimen extraction, and perioperative bleeding requiring transfusion. However, on multivariable analysis, specimen extraction site was not significant in developing IH and transfusion requirement was the strongest risk factor. CONCLUSIONS: IH development after MIS is uncommon in Korean patients. Multivariable analysis suggests that specimen extraction site can be flexibly chosen between midline and transverse incisions, with little concern about risk of developing IH. Careful efforts are required to minimize operative bleeding because blood transfusion is a strong risk factor for developing IH.

Incisión transversa infraumbilical en una embarazada con obesidad mórbida: reporte de un caso / Infraumbilical transverse incision in a pregnant woman with morbid obesity: A case report

Resumen ANTECEDENTES: El sobrepeso y la obesidad van en aumento, sobre todo en los países con bajos y medios ingresos. La obesidad en el embarazo aumenta el riesgo de complicaciones, incluida la infección del sitio quirúrgico. OBJETIVO: Documentar la aplicación de una técnica quirúrgica adaptada para disminuir la infección del sitio quirúrgico en la cesárea de una paciente con obesidad mórbida. CASO CLÍNICO: Paciente de 43 años, con 35 semanas de embarazo, con alrededor de 6 horas de percepción de disminución de los movimientos fetales y dolor abdominal, tipo contracción de moderada intensidad. Con diagnósticos de diabetes gestacional no compensada, amenaza de parto pretérmino, obesidad mórbida, añosa, preeclampsia con signos de severidad, síndrome de HELLP y alto riesgo obstétrico. Por estas características, se decidió que la incisión para la cesárea fuera transversa infraumbilical. CONCLUSIONES: La técnica de incisión aplicada en la paciente del caso evitó el contacto con el pliegue subpanicular y disminuyó las complicaciones quirúrgicas.

Abstract BACKGROUND: Overweight and obesity are increasing every day mainly in low- and middle-income countries. Obesity in pregnancy increases the risk of complications, including surgical site infection. OBJECTIVE: To document the application of a surgical technique adapted for cesarean delivery of a pregnant woman with morbid obesity in a hospital in Ecuador, carried out to reduce the infection of the surgical site. CLINICAL CASE: a 43-year-old pregnant patient who came to the hospital due to decreased fetal movements accompanied by contraction-type abdominal pain of moderate intensity. Based on the tests performed, a 35.1-week twin pregnancy + uncompensated gestational diabetes + threat of preterm birth + morbid obesity + elderly mother + pre-eclampsia with signs of severity + HELLP syndrome + high obstetric risk was diagnosed. Due to the characteristics of the patient, it was decided to perform an infraumbilical transverse incision. CONCLUSIONS: the technique used can be an effective alternative in obese patients to reduce the infection of the surgical site; Compliance with aseptic measures and preoperative antibiotic prophylaxis should also be taken into consideration.

Effectiveness of mini-transverse incision versus traditional reduced technique in the treatment of carpal tunnel syndrome. A prospective cohort study.

BACKGROUND: Carpal tunnel syndrome has attracted attention as an occupational disease due to the dramatic increase on its magnitude, and its prevalence in the general population, who's has been reported from a 0.6 to 3.4%. Currently, there are various techniques for its approach. However, there is great controversy when it comes to establishing which of the methods is the most beneficial. The objective of this study was to compare the efficacy of the mini-transverse incision against the traditional longitudinal technique in treatment of carpal tunnel syndrome. MATERIALS AND METHODS: A series of cases is presented, prospectively included, of patients with a diagnosis of carpal tunnel syndrome, who are beneficiaries of a government hospital. We present a series of cases with a diagnosis of carpal tunnel syndrome, which were performed with two different techniques. Both techniques were evaluated by comparing the recovery and work reintegration times, as well as the decrease in pain and the absence of complications. RESULTS: A total of 8 patients operated with a minimal incision and 9 with a traditional reduced incision were studied. Significant differences were shown in the days taken to return to work, with a median of 17.5 (q25-q75 14-21) days for mini-transverse incision group and of 28 (q25-q75 21-28) days for the longitudinal traditional incision group (p = 0.002). Likewise, differences were obtained in the visual analogue pain scale during the first week of evaluation 4 vs 7 (p = 0.000), in contrast to complications where there were no differences at all. CONCLUSION: The results obtained corroborate a greater efficacy of the mini-transverse incision technique, in reducing disability times. This favors the health institution to reduce the costs of rehabilitation and for the patient to have a prompt work reintegration. It is suggested to strengthen the scientific evidence that supports the use of this technique by exploring other areas such as functional status or long-term benefits.

Mini-transverse incision using a novel bush-hook versus conventional open incision for treatment of carpal tunnel syndrome: a prospective study.

PURPOSE: This study aimed to investigate the outcomes of a mini-transverse incision with a bush-hook versus a conventional open incision for carpal tunnel release (CTR). METHODS: This was a prospective study. The decision to receive either technique (mini-transverse incision with a bush-hook or conventional open incision) was primarily based on patients' choice. Patients' symptom severity, functional status, and symptomatic pain were measured at pre-operation, 1 month, and 3 and 6 months postoperatively, and any relevant complications were recorded. Kelly's scale was used to evaluate the overall clinical efficacy. RESULTS: Eighty-nine patients were included in the open CTR group and 85 patients in the mini-transverse incision group. The mini-transverse incision group had a significantly smaller incision (4.4±0.6 vs 44.8±3.7 mm), shorter surgical time (7.8±1.9 vs 21.2±3.4 min), and shorter hospital stay (3.7±1.6 vs 5.9±2.0 days) than did the open CTR group. Both groups showed significant improvements from baseline levels (all P<0.001). At postoperative 1 month and 3 months, the transverse incision group showed a significantly better VAS, SSS, and FSS (all P<0.05), but the difference was non-significant at 6 months except for FSS (P=0.022). Also, mini-transverse incision showed a significantly reduced time to return to work and activities, trend to a higher rate of excellence, and good and fewer complications than did the open CTR. CONCLUSIONS: The mini-transverse incision exhibited better performance in surgery-related measures, symptomatic remission, functional recovery, and postoperative morbidity, thus could be considered a promising technique alternative.

Laparoscopic versus Open Transverse-Incision Approach for Right Hemicolectomy: A Systematic Review and Meta-Analysis.

Background and Objectives: There is general agreement on the benefits of laparoscopy for treatment of rectal and left colon cancers, whereas findings regarding the comparison of laparoscopic and open right colonic resections are discordant. The aim of this systematic review and meta-analysis was to assess the outcomes and advantages of laparoscopic versus transverse-incision open surgery for management of right colon cancer. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating the results of laparoscopic and transverse-incision open right hemicolectomies were analyzed. The measured outcomes were mean operative time, time to feeding, duration of hospital stay, and number of lymph nodes harvested. Results: A total of 5 studies including 318 patients met the inclusion criteria. Meta-analysis revealed no differences in time to resume oral feeding, hospital stay, and number of lymph nodes harvested in between groups, but mean length of surgery was significantly longer in the laparoscopic group. Conclusion: These data confirm that the preferred approach to right hemicolectomy is yet unclear. Laparoscopy has a longer operative time than transverse-incision open surgery, and no significant short-term benefits were observed for the studied parameters. Well-designed randomized control trials (RCTs) might help to identify the differences between these two techniques for the surgical treatment of right colon cancer.

Transverse or longitudinal? A survey of volar wrist incision preferences.

INTRODUCTION: In volar wrist surgery, the traditional longitudinal incision leaves a scar that may be considered cosmetically unpleasant. Recent studies suggest that transverse wrist incisions result in more aesthetically pleasing scars that are well hidden in the wrist crease. The aim of our study was to explore the public's perceptions of longitudinal versus transverse wrist scars. METHODS: A prospective survey was conducted among the general public. Inclusion criteria were patients aged over 18 years with no prior surgery to the wrist. Survey questions assessed included: (a) longitudinal or transverse scar preference; (b) reasons for preference; and (c) demographic information. RESULTS: There were 107 respondents from the general public. More respondents preferred longitudinal scars. Top three reasons for longitudinal scar preference were: (a) perceived damage to wrist structures by a transverse incision; (b) better cosmesis; and (c) scar from the transverse incision appearing like a self-inflicted injury. Top three reasons for transverse scar preference were: (a) easily concealed by accessories; (b) less noticeable; and (c) better cosmesis. Respondents aged 60 years and above were most concerned about possible damage to wrist structures; younger respondents were most concerned that transverse scars appeared like self-inflicted injuries. CONCLUSION: Respondents from the general public preferred a longitudinal scar to a transverse one. Younger respondents were most concerned about how the transverse scar appeared like a self-inflicted injury while older respondents were most concerned with perceived functional implications of the incisions.

Left lower transverse incision versus Pfannenstiel-Kerr incision for specimen extraction in laparoscopic sigmoidectomy: a match pair analysis.

OBJECTIVE: The ideal location of specimen extraction in laparoscopic-assisted colorectal surgery is still debatable. The aim of this study was to compare the incidence of incisional hernias and surgical site infections in patients undergoing elective laparoscopic resection for recurrent sigmoid diverticulitis by performing specimen extraction through left lower transverse incision or Pfannenstiel-Kerr incision. METHODS: A total of 269 patients operated between January 2014 and December 2017 were retrospectively screened for inclusion in the study. Patients with specimen extraction through left lower transverse incision (LLT) and patients with specimen extraction through Pfannenstiel-K incision (P-K) were matched in 1:1 proportion regarding age, sex, comorbidities, and previous abdominal surgery. The incidence of incisional hernias and surgical site infections were compared by using Fisher's exact test. RESULTS: After matching 77 patients in the LLT group and 77 patients in the P-K group, they were found to be homogenous regarding the above mentioned descriptive characteristics. No patients in the P-K group developed an incisional hernia compared with 10 patients (13%) in the LLT group (p = 0.001). All these patients required hernia repair with mesh augmentation. The rate of surgical site infections was 1/77 in the P-K group and 0/77 in the LLT group (p = 1.0). In the P-K group, a wound protector was used in 86% of patients whereas in the LLT group, 39% of the wounds were protected during specimen extraction (p < 0.0001). CONCLUSION: The Pfannenstiel-Kerr incision may be the preferred extraction site compared with the left lower transverse incision given the significant reduction of the risk of incisional hernias.

Incisional hernia after cesarean section: A systematic review.

Incisional hernia is a well-known complication following abdominal surgery. A frequently performed abdominal operative procedure is cesarean section. In 2015 the median cesarean section rate in Europe was 27 % with rates up to 57 % when looking at individual countries, and the rates of cesarean sections increased with 4 % in Europe from 2010 to 2015. Nonetheless, the occurrence of incisional hernia subsequent to cesarean sections is uncertain. The aim of this study was to investigate the reported occurrence of incisional hernia after cesarean section. We included original studies with women who had given birth at least once through a cesarean section. For studies to be eligible for inclusion, a minimum follow-up period of six months as well as a population of ten or more included patients were required. The primary outcome was occurrence of incisional hernia after cesarean section. The secondary outcomes were frequency of subsequent hernia operations, and if the hernia occurrence differed between midline and lower transverse incision, and between acute and elective cesarean section. Three databases were systematically searched: PubMed, Embase, and the Cochrane Library. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guideline (PRISMA) and registered with the international prospective register of systematic reviews (PROSPERO) (registration number: CRD42019129998). A total of 2170 potentially relevant studies were identified, and of these 28 studies were identified for full text screening. Five studies met the inclusion criteria comprising 275,878 women with a previous cesarean section. The studies reported an occurrence of incisional hernia subsequent to cesarean section between 0.0-5.6 % with a follow-up time ranging from six months to ten years. Very few known risk factors for incisional hernia development were reported in the included studies. Overall, we found a low risk of incisional hernia subsequent to cesarean sections, even after a long follow-up period. Based on the included studies it was not feasible to estimate the occurrence of incisional hernia in different types of incisions, whether the urgency of the cesarean section affected the incisional hernia development, or to estimate the frequency of subsequent hernia repair. Further well-designed studies are therefore warranted.