Pfannenstiel vs. midline incision for urinary diversion, following minimally invasive radical cystectomy: single center experience

Abstract

Aim: The present study is to assess the morbidity on comparing Pfannenstiel vs. midline incision following minimally invasive radical cystectomy.Methods: This is a retrospective comparative study from February 2004 to February 2017 and the number of patients studied was 116. Patients were divided into group A (Pfannenstiel incision) and group B (midline incision). The parameters analyzed were age, gender, co-morbidity, tobacco exposure, occupation, presentation, computed tomography findings, hydronephrosis, transurethral resection of bladder tumor report, duration of surgery (in minutes), hemoglobin drop (in gram per deciliter), need for blood transfusion (number of units), hospital stay (in days), epidural analgesia, analgesic requirement, pain score on first three postoperative days (on visual analogue scale), complications, and lymph node yield (numbers). Standard steps included cystectomy with bilateral pelvic lymph-adenectomy done either through the laparoscopic or robotic approach and specimen retrieval along with diversion through either Pfannenstiel or midline incision.Results: Primary end points, post operative pain score (P = 0.0001), analgesic requirement (P = 0.0003), post operative wound complication (P = 0.002), length of hospital stay (P = 0.0003) all were less (statistically significant P < 0.05) for group A as compared to group B and secondary end points, duration of surgery (P = 0.0002), post operative paralytic ileus duration (P = 0.0006) were less (statistically significant P < 0.05) for group A as compared to group B. Other secondary end points, post operative hemoglobin drop (P = 0.08), the number of units of blood transfused (P = 0.189) and lymph node yield (P = 0.533) were comparable in either group (statistically insignificant P ≥ 0.05).Conclusion: Minimally invasive (laparoscopic or robotic) radical cystectomy with an extra-corporeal diversion through Pfannenstiel incision offers an advantage of less morbidity than midline incision