Postsurgical pain outcome of vertical and transverse abdominal incision: Design of a randomized controlled equivalence trial ISRCTN60734227Reportar como inadecuado

Postsurgical pain outcome of vertical and transverse abdominal incision: Design of a randomized controlled equivalence trial ISRCTN60734227 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Surgery

, 3:9

First Online: 13 November 2003Received: 17 October 2003Accepted: 13 November 2003


BackgroundThere are two ways to open the abdominal cavity in elective general surgery: vertically or transversely. Various clinical studies and a meta-analysis have postulated that the transverse approach is superior to other approaches as regards complications. However, in a recent survey it was shown that 90 % of all abdominal incisions in visceral surgery are still vertical incisions. This discrepancy between existing recommendations of clinical trials and clinical practice could be explained by the lack of acceptance of these results due to a number of deficits in the study design and analysis, subsequent low internal validity, and therefore limited external generalisability. The objective of this study is to address the issue from the patient-s perspective.

MethodsThis is an intraoperatively randomized controlled observer and patient-blinded two-group parallel equivalence trial. The study setting is the Department of General-, Visceral-, Trauma Surgery and Outpatient Clinic of the University of Heidelberg, Medical School. A total of 172 patients of both genders, aged over 18 years who are scheduled for an elective abdominal operation and are eligible for either a transverse or vertical incision. To show equivalence of the two approaches or the superiority of one of them from the perspective of the patient, a primary endpoint is defined: the pain experienced by the patient VAS 0–100 on day two after surgery and the amount of analgesic required piritramide mg-h. A confidence interval approach will be used for analysis. A global α-Level of 0.05 and a power of 0.8 is guaranteed, resulting in a size of 86 patients for each group. Secondary endpoints are: time interval to open and close the abdomen, early-onset complications frequency of burst abdomen, postoperative pulmonary complications, and wound infection and late complications frequency of incisional hernias. Different outcome variables will be ranked by patients and surgeons to assess the relevance of possible endpoints from the patients- and surgeons- perspective.

ConclusionThis is a randomized controlled observer and patient-blinded two-group parallel trial to answer the question if the transverse abdominal incision is equivalent to the vertical one due to the described endpoints.

Abbreviations and DefinitionsCRFCase Report Form

VASVisual Analogue Scale

RCTrandomized controlled trial


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Autor: Margot A Reidel - Hanns-Peter Knaebel - Christoph M Seiler - Christine Knauer - Johann Motsch - Norbert Victor - Markus W


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