Modified Makuuchi incision for major upper abdominal surgeries

Abstract

Background: Numerous incisions are described for abdominal operations. However, opinion is divided regarding the correct choice of incision for major upper abdominal surgeries. Material & methods: Experience of 3 surgical centres with the use of modified Makuuchi incision, for major upper abdominal surgeries, from Mar 2014- Dec 2018, was audited. Results: 144 patients [76 Males: 68 Females] with an average age of 48.25 years underwent surgery using modified Makuuchi incision. ’J’ and ‘L’ incisions were used in 96 and 48 patients, respectively. Further extension of the incision was necessary in 2 patients. Adequate exposure and enhanced surgical ergonomics was observed in all cases. Surgical site infection was seen in 19 patients [13.2%]. Incisional hernias was observed in 6 patients [4.2%], on an average follow up of 27.78 months. Conclusions: Modified Makuuchi incision proves efficacious for major upper abdominal surgeries.

Evaluation of Modified Makuuchi Incision in Terms of Postoperative Pain, Incisional Hernia, and Cosmetics: Observational Study

“…Chang et al reported that the rate of incisional hernia after MMI was 10.9%. 2 It was reported 4.2% by Pandit et al and 12% by Ruffolo et al 4,5 In the study by Togo et al, hernia frequencies after median and J-shaped incisions were 6.3% and 4.7%, respectively. 10 In our study, according to the patients' own statements, there was a bulging in one patient and a hernia in one patient at the surgery site.…”

“…In their study of 144 cases, Pandit et al showed that the MMI provided many operative ergonomics and less postoperative pain according to thoracoabdominal and inverted T incision. 5 The midline incision of this approach spares muscles through the linea alba, and the lateral one is quite far away from the costal margin, causing limited nerve injury through a single dermatome. It is believed that these are the principles to reduce post-operative skeletal muscle laxity, pain, and dysesthesia.…”

A comparative study on analgesic and non-analgesic outcomes of inter pleural analgesia compared to thoracic epidural analgesia in open pancreatico-duodenectomy

“…A combination of vertical and horizontal incision created with ‘reverse L’ or ‘J’ incision techniques offer maximal exposure to the right upper quadrant of the abdomen. The ‘reverse L’ incision is preferred over the ‘reverse J’ incision as the horizontal limb of the latter is more proximal to the rib case, resulting in more pain with more associated complications [ 17 , 18 ]. For access to the pancreatic body or tail, a bilateral subcostal or midline incision is necessary.…”

Usage of Modified Makuuchi Incision for Surgical Management of Complex Renal and Adrenal Lesions

“…The utility of Makuuchi incision in major upper abdominal surgeries is described in great depth by Pandit et al In their experience of 144 cases of upper gastrointestinal and hepato-pancreatico-biliary surgeries, the authors have described that the incision provided superior operative ergonomics, ease of entry and closure, ease of extension whenever required, maintained muscle integrity and resulted in less postoperative pain [ 7 ].…”

“…This was later modified by Chang, in which the vertical limb remained the same whereas the horizontal limb curves laterally as a reverse L in parallel to the anatomic abdominal skin fold at the level of umbilicus and also along the dermatomal distribution of the nerves to end at the midpoint between the lowest rib and the anterosuperior iliac spine [ 6 ]. The utility of these incisions has been described in great depth in a wide variety of foregut and hepatobiliary surgeries [ 6 - 7 ] but to a limited extent in upper abdominal urological surgeries. We routinely use MM incision for its unique advantages like the unparalleled exposure of great vessels in their entirety along with the lesion of interest and liver mobilization which greatly helped us in dealing with a variety of renal, adrenal, and renovascular conditions.…”