title: A J-shaped subcostal incision reduces the incidence of abdominal wall complications in liver transplantation.
abstract: A novel J-shaped incision for liver transplantation was introduced in attempt to reduce the wound-related complication rate while maintaining comparable access. Some 58 consecutive patients with the classic Mercedes incision were compared with the following 60 consecutive patients with a J-shaped incision. Nine of 60 patients (15%) with a J-shaped incision were converted to an extensive incision. The duration of surgery did not differ between both groups, and relaparotomy rates were comparable in both groups (45% versus 31%, P = 0.487) whereas the early wound-related morbidity was significantly reduced in the J-shaped incision group (3% versus 19%, P = 0.009), as well as incisional hernia rate (7% versus 24%, P = 0.002, corrected for different length of follow-up). Other factors such as previous surgery, ascites, abdominal drainage, retransplantation, and indications for transplantation did not differ between both groups and were not predictive of wound-related morbidity or incisional hernia. We therefore conclude that a J-shaped incision should be the incision of choice in liver transplantation. This new, seemingly minor modification reduces wound infections, fascial dehiscence, and incisional hernia.
authors.affiliation: Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
authors.forename: Hendrik A
authors.initials: HA
authors.lastname: Marsman
authors.forename: Hassan
authors.initials: H
authors.lastname: Eker
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D034861:Abdominal Wall; D002102:Cadaver; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006547:Hernia / Q000473:pathology; D006801:Humans; D015994:Incidence; D008099:Liver / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D011183:Postoperative Complications / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing