Pfannenstiel versus Vertical Laparotomy in Patients Undergoing Radical Retropubic Prostatectomy with Spinal Anesthesia: Results of a Prospective, Randomized Trial

Salonia, Andrea; Suardi, Nazareno; Crescenti, A.; Zanni, Giuseppe; Fantini, Gemma; Gallina, Andrea; Ghezzi, Massimo; Colombo, Renzo; Montorsi, Francesco; Rigatti, Patrìzio

doi:10.1016/j.eururo.2004.07.025

Cited by 14 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a prospective randomized trial of patients undergoing ORP, no incisional hernias occurred at the 6-month follow-up regardless of the type of laparotomy (standard vertical vs. Pfannenstiel transverse). 21 Despite the small sample size, the study may support the idea that mechanical factors are important in incisional hernia formation and may further explain the lower incisional hernia rate in infra-umbilical incisions more common in ORP.…”

Section: Discussionmentioning

confidence: 54%

Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

et al. 2013

View full text Add to dashboard Cite

Purpose The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. Materials and Methods In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset we identified men age 66 and older who had minimally invasive (MIRP) or open radical prostatectomy (ORP) for prostate cancer diagnosed 2003–2007. The main outcome was incisional hernia repair identified in Medicare claims following prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. Results We identified 3,199 patients who had MIRP and 6,795 who had open radical prostatectomy ORP. The frequency of incisional hernia repair was 5.3% (median follow-up 3.1 years) in the MIRP group and 1.9% (median follow-up 4.4 years) in the ORP group, corresponding to incidence rates of 16.1 and 4.5 per 1000 person-years for MIRP and ORP, respectively. Compared with ORP, MIRP was associated with a more than 3-fold increased risk of incisional hernia repair, controlling for patient and disease characteristics (adjusted hazard ratio 3.39, 95% CI, 2.63–4.38, p <0.0001). MIRP was associated with an attenuated but increased risk of any hernia repair compared with ORP (adjusted hazard ratio 1.48, 95% CI 1.29–1.70, p <0.0001). Conclusions MIRP was associated with a significantly increased risk of incisional hernia compared with ORP. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique.

show abstract

Section: Discussionmentioning

confidence: 54%

Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

et al. 2013

View full text Add to dashboard Cite

show abstract

“…However, their findings do not apply well because the incisions were below the navel and were extraperitoneal, which has a much lower risk of hernia formation than trans-peritoneal procedures above the navel. 9 …”

mentioning

confidence: 99%

Transverse Versus Vertical Camera Port Incision in Robotic Radical Prostatectomy: Effect on Incisional Hernias and Cosmesis

Beck

Skarecky

Osann

et al. 2011

Urology

View full text Add to dashboard Cite

OBJECTIVE To examine the incidence of incisional hernias (IHs) and propose a simple modification to reduce the incidence of IHs. Robot-assisted radical prostatectomy (RARP) historically uses a vertical midline camera port incision to extract the prostate. METHODS Of 900 consecutive RARPs, the initial 735 had a vertical and subsequent 165 transverse incisions. Two methods were used to identify IHs: clinic visits noted in the prospective database and screening using electronic mail. We compared the baseline factors between the vertical IH and IH-free cohorts. The maximal scar width was recorded in 178 consecutive men presenting to our clinic: vertical (n = 107) and transverse (n = 71). RESULTS IHs occurred significantly more often after a vertical incision (5.3% vs 0.6%, P = .005). The IH rates after a vertical incision could be estimated to be as great as 16.7% (18 of 108) using the electronic mail respondents or as low as 3.3% (21 of 627) according to clinic follow-up. On univariate analysis, baseline age, International Index of Erectile Function 5-item questionnaire, prostate weight, bother score (all P ≤ .05), and body mass index (P = .058) were associated with an increased risk of an IH. After adjusting for baseline factors on multivariate logistic regression analysis, the relative odds of developing an IH with a vertical versus transverse incision was 11 (95% confidence interval 1.5–82). The average maximal scar width was reduced from 5.5 to 2.0 mm (P < .0001). CONCLUSION In the present sample population, the vertical IH rate was estimated to be potentially as low as 3.3% or as great as 16.7%. On multivariate analysis, a greater body mass index and larger prostate size significantly increased the risk of hernia development. Transverse incisions dramatically reduced the rate of IHs and the maximal scar width. The IH rates varied significantly by reporting method.

show abstract

“…ORP through Pfannenstiel incision has been described, and Salonia et al . [6] confirmed that it is equally safe and effective as the standard midline incision for performing ORP. The popularity of the lower transverse Pfannenstiel incision in gynecologic surgery arises from the fact that these incisions can easily be concealed, contributing to the aesthetic appeal of this approach.…”

Section: Discussionmentioning

confidence: 95%

“…[23] Other reports have altered the orientation and technique of the incision to achieve better outcomes. [4–6]…”

Section: Introductionmentioning

confidence: 99%

Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions

et al. 2010

View full text Add to dashboard Cite

Aims:Open radical retropubic prostatectomy (ORP) has traditionally been performed through a lower midline incision. Prior efforts to reduce pain and expedite recovery include a variety of alterations in length and the orientation of the incision. The aim of our study is to compare the safety, efficacy, and cosmetic outcomes associated with transverse and longitudinal mini-radical prostatectomy incisions.Materials and Methods:Consecutive patients undergoing ORP at a single institution were studied. Patients were randomized to receive either a modified transverse or longitudinal incision. In all patients, the length of the incision was 7cm. The following parameters were compared between the two groups: Perioperative blood loss, duration of surgery, technical factors, pain and analgesic requirements, length of hospital stay (LOS), and pathological stage. The Patient and Observer Scar Assessment Scale (POSAS) was used to compare the cosmetic aspects associated with the incisions.Results:Fifty-six patients underwent a transverse (n=27) and longitudinal (n=29) mini- incision ORP. No significant differences were noted in the perioperative parameters that were compared (P>0.116). None of the patients required blood transfusion, there were no wound complications. Perioperative pain and analgesic requirements were not significantly different among the two study arms (P>0.433). The POSAS indicated no significant difference in cosmesis scores with both incisions (P>0.09).Conclusions:Seven-centimeter transverse and longitudinal mini-incisions offer alternatives to the standard ORP incision, and to minimally invasive approaches. Both incisions are safe, associated with little postoperative pain, and a short postoperative LOS. Both incisions provide highly satisfactory cosmesis for the patient.

show abstract

Pfannenstiel versus Vertical Laparotomy in Patients Undergoing Radical Retropubic Prostatectomy with Spinal Anesthesia: Results of a Prospective, Randomized Trial

Cited by 14 publications

References 20 publications

Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

Transverse Versus Vertical Camera Port Incision in Robotic Radical Prostatectomy: Effect on Incisional Hernias and Cosmesis

Prospective randomized comparison of the safety, efficacy, and cosmetic outcome associated with mini-transverse and mini-longitudinal radical prostatectomy incisions

Contact Info

Product

Resources

About