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Indian Journal of Public Health Research & Development
Year : 2019, Volume : 10, Issue : 7
First page : ( 938) Last page : ( 942)
Print ISSN : 0976-0245. Online ISSN : 0976-5506.
Article DOI : 10.5958/0976-5506.2019.01698.X

Comparative Study between Muscle-Split Versus the Classical Muscle-Cut Subcostal Incision for Open Cholecystectomy

Sultan Awni Ismail1, Hussein Khalid Khairi1,*

1Department of Surgery, College of Medicine, Tikrit University, Salah Al-Deen, Iraq

*Corresponding Author: Khalid Khairi Hussein, Professor in The College of Medicine, Tikrit University, Tikrit, Iraq, Phone: 07722958462, Email: dr_khalidkhairy@yahoo.com

Online published on 19 August, 2019.

Abstract

Introduction

Many incisions have been advocated and used for open cholecystectomy. The right subcostal incision is commonly chosen, in which abdominal wall muscles divided in the line of incision. The aim of this study is to unreveal whether muscle splitting incision for open cholecystectomy affects operative duration and blood loss, postoperative pain, duration of hospitalisation, then subsequent local complications namely, wound infection and incisional hernia compared with the traditional rectus muscle dividing open cholecystectomy.

Methodology

Analytic study included adult cases (n=120) that were undergone a right-sided subcostal incisions for open cholecystectomy, who were not candidates for laparoscopic approach or those were converted to open version. They were randomly divided into two groups (n=60 each) depend on the operation type viz. classical muscle-cut subcostal incision (MCSI) group and same length, muscle-split subcostal incision (MSSI) group. Patients were examined for operative time (calculated from starting incision till closure of skin), intraoperative blood loss, postoperative pain (using the visual analogue score), and length of hospitalization. Six weeks postoperatively, all incisions were followed, and any case of surgical site infection or incisional hernia was reported.

Results

Regarding operative variables, the operative time is more in group MSSI (92.7min) with less blood loss (12.3ml) than that in group MCSI (86.4 min) with more blood loss (28.6ml). The postoperative pain is significantly less in group MSSI as compared to MCSI depending on visual analogue score, as the following: day 1 (3.44 Vs. 1.56), day 2 (1.78 Vs. 0.90), and day 3(1.18 Vs. 0.76). Six weeks postoperative follow up showed that 11 patients as 7(11.6%) in group MCSI, and 4(6.6%) of group MSSI) developed surgical site infection; all were treated as outpatient cases. Besides, 4 patients as 3 patients (5%) in group MCSI, and only 1case (1.6%) of group MSSI developed incisional hernia requiring surgical repair.

Conclusion

Muscle split subcostal incision is quite suitable for uncomplicated open cholecystectomy with less operative blood loss, less postoperative pain, earlier discharge, and less postoperative complications, namely wound infection and incisional hernia.

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Keywords

Laparoscopic cholecystectomy, Muscle split subcostal incision, Muscle-cut subcostal incision, Postoperative complications.

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