Compared to standard laparotomy incisions, the pfannenstiel incision has been shown to result in decreased pain, fewer wound complications, faster recovery, and better cosmesis. However, gastrointestinal surgeons have rarely used this incision, primarily due to inadequate exposure to intraperitoneal structures. The ability to mobilize the bowel laparoscopically allows for the possibility of using the pfannenstiel incision for a variety of intestinal operations.
METHODS: 28 cases (May 1998 to October 2000) were performed in which the pfannenstiel incision was used. The operative technique generally involved initial laparoscopic mobilization of the hepatic and/or splenic flexure, thereby bringing the bowel into the operative field. Data were compiled by review of the medical records and patient questionnaire.
RESULTS: 11 males and 17 females underwent surgery, the average age being 40 +/- 15 (SD) years. The procedures included ileocolectomy (20), small bowel resection (3), sigmoid resection (3), total abdominal colectomy (1), and lysis of adhesions (1). 20 patients had Crohn s disease, 8 of whom had complicated disease including fistulae (3 ileovesicle, 5 ileosigmoid) and/or abscess (2) at the time of surgery. There were no conversions to other laparotomy incisions. The operative time averaged 151 +/- 40 minutes, the median length of hospital stay was 4 +/- 1.5 days, with first flatus occurring on day 3 +/- 1.2. Post-operative complications included early small bowel obstruction (1) and abscess requiring percutaneous drainage (2). At follow up, patients reported a median time to return to full activity of 28 +/- 15 days. Narcotic pain medication was required for 5 +/- 5 days after hospital discharge, however 8 patients reported not requiring any pain medication at home. All patients reported excellent satisfaction with the procedure and the cosmetic result.
CONCLUSIONS: The laparoscopically-assisted pfannenstiel operation is feasible for a variety of gastrointestinal surgical procedures, even those involving extensive inflammatory processes such as abscess and/or fistulae. The technique provides excellent results in regard to overall morbidity and cosmesis and may be a preferred alternative to the standard midline laparotomy.