Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions.
BACKGROUND
The optimal abdominal incision for partial hepatectomy has not been established.


METHODS
A prospective hepatobiliary surgery database was retrospective reviewed. Patients with Mercedes and extended right subcostal (ERSC) incisions were identified and compared.


RESULTS
Between December 1991 and September 2001 a total of 1426 patients met the inclusion criteria. Among them, 856 (60%) had a Mercedes incision and 570 (40%) an ERSC incision. The two groups were well matched for demographics and operative variables. Perioperative morbidity and pulmonary complications were similar for the two groups as well. There was no difference in terms of early wound complications, although incisional hernias occurred in 9.8% of patients with a Mercedes incision compared to 4.8% of those with an ERSC incision (P = 0.0001). On multivariate analysis, the incision type, along with gender, body mass index, and age, were significant predictors of incisional hernia.


CONCLUSIONS
An ERSC incision for partial hepatectomy provides adequate, safe access and is associated with fewer long-term wound complications.
D'Angelica
Michael
M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
Maddineni
Sridevi
S
Fong
Yuman
Y
Martin
Robert C G
RC
Cohen
Michael S
MS
Ben-Porat
Leah
L
Gonen
Mithat
M
DeMatteo
Ronald P
RP
Blumgart
Leslie H
LH
Jarnagin
William R
WR
D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006555:Hernia, Ventral / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome