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Purpose: To investigate rectus atrophy after abdominal surgery through a midline versus Chevron incision.
Methods: We performed a retrospective analysis of all patients that underwent open pancreaticobiliary surgery at our institution between 2007 and 2011. Of the 210 patients included in the study, 180 underwent an operation through a midline incision and 30 through a Chevron incision. The two groups were defined by patient demographics, preoperative albumin, diagnosis, type of operation and adjuvant therapies. We measured rectus abdominis muscle thickness on preoperative and follow-up CT scans to calculate percent atrophy of the muscle after surgery. We additionally recorded incisional hernias as reported by the radiologist on the postoperative CT scan.
Results: The two groups, midline and chevron, had patient populations of similar characteristics with average follow up of 18.1 and 24.5 months respectively. The midline group demonstrated significantly less average rectus atrophy, 2.90% compared to the chevron group with 21.8% atrophy (p<0.001). Additionally there was no statistical difference between the number of incisional hernias on CT scan for the midline group, 8.33% versus 6.67% in the chevron (p=0.76)
Conclusions: Patients who underwent an open operation through a midline incision demonstrated significantly less atrophy as compared to those patients who underwent an operation through a Chevron incision. This resulting atrophy is most likely secondary to the disruption of the intercostal nerves and innervation to the rectus abdominis with Chevron incisions, which is avoided during midline incisions. Additionally our results showed there was no significant difference between the groups for other morbidities such as incisional hernias. Thus from our experience a midline incision is associated with less postoperative changes and should be the preferred abdominal incision. Additional studies may be conducted to further evaluate the morbidity associated with rectus abdominis atrophy.