TO COMPARE THE SEVERITY OF POST OPERATIVE PAIN AND INCIDENCE OF INCISIONAL HERNIA IN OPEN CHOLECYSTECTOMY: RECTUS SPARING V/S RECTUS CUTTING INCISIONS

Abstract

Objective: To compare the severity of post-operative pain and incidence of incisional hernia in open cholecystectomy while making rectus sparing and rectus cutting incisions in patients with symptomatic cholelithiasis.

Study Design: Randomized controlled trial.

Place and Duration of Study: Combined Military Hospital Skardu, three years with effect from May 2012 to May 2015.

Material and Methods: Patients meeting the inclusion criteria who underwent elective open cholecystectomy were included in the study. Written informed consent was taken before surgery. Approval of hospital ethics committee was also granted. Patients were divided into two groups “I" and "II" of sixty one patients each. In group "I", patients underwent open cholecystectomy by making rectus sparing subcostal incision. In group "2",
patients underwent open cholecystectomy by making rectus cutting subcostal incision. Patients were assessed on 1st, 2nd and 7th postop days for severity of pain using visual analogue score. Patients in both groups were also followed up to look for development of incisional hernia.

Results: Severity of post-operative pain is much less in patients undergoing open cholecystectomy by making rectus sparing subcostal incision. However no difference was noted in both techniques in terms of incidence of incisional hernia as no patient in any group developed this morbidity.

Conclusion: Use of rectus sparing subcostal incision was found more feasible in open cholecystectomy in terms of severity of postoperative pain as compared to rectus cutting incision. However, both techniques did not reveal any difference in terms of incidence of incisional hernia as no patient in either group developed hernia on six months follow up.