DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H.Incisional hernia, midline versus low transverse incision
: what is the ideal incision for specimen extraction and handassisted laparoscopy?
The low transverse incision
site is best visualized in the sagittal plane reformat on CT or MRI and the vertical incision site is best visualized on axial CT or MRI (Figs.
The abdomen was opened by a low transverse incision
. Intraoperative around 40 x 15 cm sized left ovarian cyst (Figure 1) was seen; no healthy ovarian tissue was seen separately.
Laparotomy in supine position by low transverse incision
revealed well-developed uterus and ovary.
In one of the two large observational studies done in the United States that have shed light on TOLAC outcomes, the rate of uterine rupture among women who underwent TOLAC was 0.7% for women with a prior low transverse incision
, 2.0% for those with a prior low vertical incision, and 0.5% for those with an unknown type of prior incision.
For women undergoing cesarean delivery via low transverse incision
, if staples are removed on day 3, the incidence of wound separation is higher--as both this study and earlier studies have demonstrated--so suture may be preferred, if, however, staples are removed later than day 3, data are insufficient to compare wound morbidity on the basis of skin closure techniques.
A low transverse incision
is the preferred technique for abdominal hysterectomy.
Physicians now know that the classical, low vertical and "inverted T" incisions have a higher rate of rupture than the low transverse incision
now in general use.
The American College of Obstetricians and Gynecologists (ACOG) now recommends that most women with one previous cesarean delivery and with a low transverse incision
be counseled about VBAC and offered a trial of labor.
So if there's a chance of doing a low transverse incision
, take it.
However, the rupture rate drops to between 0.5% and 1% in women who have a prior low vertical or low transverse incision
ACOG states that a woman with two or more previous cesareans deliveries with low transverse incisions
who wishes to plan a VBAC should not be discouraged from doing so in the absence of contraindications.