Impact of Abdominal Incision Type on Postoperative Pain and Quality of Life Following Hepatectomy

Abstract

Background

The aim of this prospective study was to analyze the impact of abdominal incision type on postoperative pain and quality of life (QOL) in hepatectomy.

Methods

In patients undergoing hepatectomy by open, hybrid, or pure laparoscopic approaches, we classified abdominal incisions as: pure laparoscopic (LAP), midline (MID), J-shaped (J), and J-shaped incision plus thoracotomy (TRC). Postoperative pain was measured on postoperative day (POD) 3, 7, 30, and 90 using a visual analog scale (VAS). QOL was evaluated using the short-form-36 questionnaire preoperatively and on POD 30 and 90.

Results

We categorized 165 patients into LAP (n = 9, 5%), MID (n = 21, 13%), J (n = 95, 58%), and TRC (n = 40, 24%) groups. Median VAS scores on PODs 3/7/30/90 were: LAP, 27.5/7.5/10/10; MID, 30/10/15/5; J, 50/27.5/20/10, and TRC, 50/30/30/19. The J and TRC groups had significantly higher VAS scores vs. MID on PODs 3 and 7; the LAP and MID groups did not differ significantly. No significant positive correlations were observed between incision length and postoperative VAS, when we stratified patients into two groups according to the presence or absence of a transverse incision. Physical QOL summary scores did not return to preoperative levels even on POD 90, in patients with an additional transverse incision. Mental QOL summary scores worsened with postoperative complications rather than with abdominal incision type.

Conclusions

Transverse incisions, rather than incision length, led to worse midline incision pain and poorer QOL recovery post-hepatectomy. A hybrid approach may be a considerable option when pure laparoscopic hepatectomy is technically difficult.

Trial registration

This study was registered in the UMIN Clinical Trials Registry (registration number: UMIN000017467; http://www.umin.ac.jp/ctr/index.htm)

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Abbreviations

QOL:

Quality of life

VAS:

Visual analog scale

POD:

Postoperative day

LAP:

Pure laparoscopic incision

MID:

Midline incision

J:

J-shaped incision

TRC:

J-shaped incision plus thoracotomy

References

  1. 1.

    Hu Y, Huang C, Sun Y et al (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357

    Article  Google Scholar 

  2. 2.

    Nelson H, Sargent DJ, Wieand HS et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    CAS  Article  Google Scholar 

  3. 3.

    de Rooij T, van Hilst J, van Santvoort H et al (2019) Minimally invasive versus open distal pancreatectomy (LEOPARD). Ann Surg 269:2–9

    Article  Google Scholar 

  4. 4.

    Fretland AA, Dagenborg VJ, Bjørnelv GMW et al (2018) Laparoscopic versus open resection for colorectal liver metastases. Ann Surg 267:199–207

    Article  Google Scholar 

  5. 5.

    Wakabayashi G, Cherqui D, Geller D et al (2015) Recommendations for laparoscopic liver resection. Ann Surg 261:619–629

    PubMed  Google Scholar 

  6. 6.

    Mise Y, Satou S, Ishizawa T et al (2014) Impact of surgery on quality of life in patients with hepatocellular carcinoma. World J Surg 38:958–967

    Article  Google Scholar 

  7. 7.

    Ishizawa T, Hasegawa K, Kokudo N et al (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51

    Article  Google Scholar 

  8. 8.

    Lim C, Ishizawa T, Miyata A et al (2016) Surgical indications and procedures for resection of hepatic malignancies confined to segment VII. Ann Surg 263:529–537

    Article  Google Scholar 

  9. 9.

    Ishizawa T, Kokudo N, Makuuchi M (2008) Right hepatectomy for hepatocellular carcinoma. Is the anterior approach superior to the conventional approach? Ann Surg 247:390–400

    Article  Google Scholar 

  10. 10.

    Ishizawa T, Gumbs AA, Kokudo N et al (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964

    Article  Google Scholar 

  11. 11.

    Oba A, Ishizawa T, Mise Y et al (2019) Possible underestimation of blood loss during laparoscopic hepatectomy. BJS Open 3:336–343

    CAS  Article  Google Scholar 

  12. 12.

    Fukuhara S, Bito S, Green J et al (1998) Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol 51:1037–1044

    CAS  Article  Google Scholar 

  13. 13.

    Fukuhara S, Ware JE, Kosinski M et al (1998) Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol 51:1045–1053

    CAS  Article  Google Scholar 

  14. 14.

    Torphy RJ, Chapman BC, Friedman C et al (2019) Quality of life following major laparoscopic or open pancreatic resection. Ann Surg Oncol 26:2985–2993

    Article  Google Scholar 

  15. 15.

    Seiler CM, Deckert A, Diener MK et al (2009) Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg 249:913–920

    Article  Google Scholar 

  16. 16.

    Proske JM, Zieren J, Müller JM (2005) Transverse versus midline incision for upper abdominal surgery. Surg Today 35:117–121

    Article  Google Scholar 

  17. 17.

    Jain A, Nemitz P, Sharma R et al (2009) Incidence of abdominal wall numbness post-liver transplantation and its complications. Liver Transpl 15:1488–1492

    Article  Google Scholar 

  18. 18.

    Imamura H, Soyama A, Takatsuki M et al (2013) Self-assessment of postoperative scars in living liver donors. Clin Transplant 27:E605-610

    Article  Google Scholar 

  19. 19.

    Soyama A, Takatsuki M, Hidaka M et al (2012) Standardized less invasive living donor hemihepatectomy using the hybrid method through a short upper midline incision. Transplant Proc 44:353–355

    CAS  Article  Google Scholar 

Download references

Acknowledgement

We thank Jane Charbonneau, DVM, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.

Funding

This study was supported by a Joint Research Fund from Nipro Corporation.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kiyoshi Hasegawa.

Ethics declarations

Conflict of interest

None of the authors have actual or potential conflicts of interest regarding the submission of this article.

Ethics statement

This study was performed in accordance with the guidelines of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Watanabe, G., Ishizawa, T., Yamamoto, S. et al. Impact of Abdominal Incision Type on Postoperative Pain and Quality of Life Following Hepatectomy. World J Surg (2021). https://doi.org/10.1007/s00268-021-05992-x

Download citation