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.
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.
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.
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.
This study was registered in the UMIN Clinical Trials Registry (registration number: UMIN000017467; http://www.umin.ac.jp/ctr/index.htm)
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Quality of life
Visual analog scale
Pure laparoscopic incision
J-shaped incision plus thoracotomy
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We thank Jane Charbonneau, DVM, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.
This study was supported by a Joint Research Fund from Nipro Corporation.
Conflict of interest
None of the authors have actual or potential conflicts of interest regarding the submission of this article.
This study was performed in accordance with the guidelines of the Declaration of Helsinki.
Informed consent was obtained from all individual participants included in the study.
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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