Evaluation of the Pfannenstiel incision for radical abdominal hysterectomywith pelvic and para-aortic lymphadenectomy

Radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy (RAH/P + PAL) has classically been described through a low midline vertical incision. Transverse incisions have been used with good results for variou s pelvic surgical procedures. Hesitancy has been encountered when utilizing these transverse incisions in gynecologic oncology patients. In most studi es, muscle-splitting transverse incisions seem to be of equal efficacy as m idline vertical incisions in regards to surgical exposure and clinicopathol ogic data obtained and are known to be superior in cosmesis and postoperati ve morbidity. A retrospective chart review was performed to identify 25 pat ients who underwent RAH/P + PAL for stage I carcinoma of the cervix from 19 90 to 1998 through a nonmuscle splitting (Pfannenstiel) abdominal incision. All patients were seen and had follow-up in the Division of Gynecologic On cology, University of Miami School of Medicine/Jackson Memorial Medical Cen ter (Miami, FL). Data were collected on various clinical and surgical param eters including height/weight, operative time, blood loss, number of lymph nodes obtained, length of hospital stay, and postoperative complications. A nalysis of the data revealed that operative time and average blood loss wer e within acceptable parameters. The yield at lymphadenectomy for pelvic and para-aortic lymph nodes was also respectable. Postoperative complications were minimal and there were no wound complications reported. Therefore, the Pfannenstiel incision can be safely utilized in a select group of patients undergoing RAH/P + PAL.