Low Transverse versus Midline Abdominal Skin Incisions for in utero Spina Bifida Repair

Michal Fishel Bartal; Eric P Bergh; Kuojen Tsao; Mary T Austin; Kenneth J Moise; Stephen A Fletcher; Baha M Sibai; Ramesha Papanna

doi:10.1159/000512045

Low Transverse versus Midline Abdominal Skin Incisions for in utero Spina Bifida Repair

Fetal Diagn Ther. 2021;48(3):174-182. doi: 10.1159/000512045. Epub 2021 Feb 16.

Authors

Michal Fishel Bartal¹, Eric P Bergh¹, Kuojen Tsao², Mary T Austin², Kenneth J Moise¹, Stephen A Fletcher³, Baha M Sibai¹, Ramesha Papanna⁴

Affiliations

¹ The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
² Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, The Fetal Center and the Memorial Hermann Hospital, Houston, Texas, USA.
³ Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, The Fetal Center and the Memorial Hermann Hospital, Houston, Texas, USA.
⁴ The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA, Ramesha.Papanna@uth.tmc.edu.

PMID: 33592609
DOI: 10.1159/000512045

Abstract

Objective: The 2 types of maternal skin incisions for in utero spina bifida repair are low transverse (LT) incision perceived to be cosmetic benefit and midline longitudinal (ML) incision, typically associated with a reduction in surgical time and lower blood loss. Our objective was to compare short- and long-term outcomes associated with these 2 types of skin incisions following in utero spina bifida repair.

Methods: Prospective observational cohort of 72 patients undergoing fetal spina bifida repair at a single institution between September 2011 and August 2018. The decision for the type of incision was at the discretion of the surgeons. The primary outcome was total operative time. Secondary outcomes included an analog scale of wound pain score on postoperative day 3, duration of postoperative stay, and postoperative wound complications within the first 4 weeks. The Patient Scar Assessment Questionnaire, a validated questionnaire, was obtained for all patients (≥6 months from delivery) using 4 categories (appearance, consciousness, satisfaction with appearance and with symptoms), with higher scores reflecting a poorer perception of the scar.

Results: There were 43 women (59.7%) in the LT group and 29 (40.3%) in the ML group. In all patients, the same incision was used during cesarean delivery. The total operative time was higher in the LT group by 33 min (p < 0.001), primarily due to abdominal wall incision time (open and closure). No significant differences were found between the groups in pain score, length of postoperative stay, or the rate of wound complications. Fifty-three patients (73.6%) responded to the questionnaire, 36/43 from the LT group and 17/29 from the ML group. There was no difference in the scores of appearance, consciousness, and satisfaction with appearance and symptoms between the groups.

Conclusion: ML incisions shorten operative times without altering long-term incision-related satisfaction when compared to LT incisions.

Keywords: Fetal surgery; Myelomeningocele; Scar assessment; Skin incisions; Spina bifida; Wound complications.

Publication types

Observational Study

MeSH terms

Abdominal Wall*
Cesarean Section
Cohort Studies
Female
Humans
Postoperative Complications
Pregnancy
Spinal Dysraphism* / surgery