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

World Journal of Surgery (2021)Cite this article

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)

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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

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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.

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Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Genki Watanabe, Takeaki Ishizawa, Satoshi Yamamoto, Takashi Kokudo, Yujiro Nishioka, Akihiko Ichida, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita & Kiyoshi Hasegawa

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  1. Genki Watanabe
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  2. Takeaki Ishizawa
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  3. Satoshi Yamamoto
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  4. Takashi Kokudo
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  5. Yujiro Nishioka
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  6. Akihiko Ichida
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  7. Nobuhisa Akamatsu
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  8. Junichi Kaneko
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  9. Junichi Arita
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  10. Kiyoshi Hasegawa
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Corresponding author

Correspondence to Kiyoshi Hasegawa.

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Ethics statement

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

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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

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