In “J” Laparotomy. An Alternative Pathway for High Abdominal Surgery

In “J” Laparotomy. An Alternative Pathway for High Abdominal Surgery

Main Article Content

Carlos Manterola


Pathways for high abdominal surgery (HAS) are vertical, oblique and transverse laparotomies. A variety of these is known as “in J laparotomy” (JL). The aim of this study is to analyze the results obtained with JL in HAS, in terms of local postoperative complications (LPC) respect of vertical laparotomies (VL). Historical cohort study. The sample consisted of patients operated for HAS consecutively between 1996 and 2012 (17 years), at the Hospital Clínico de la Universidad Mayor. The outcome variable was development of LPC. Other variables of interest were diagnosed at admission, surgery performed, hospital stay, surgical time and type of wound. The cohort of patients undergoing JL was compared with other patients with VL. The patients had a minimum follow-up of 12 months. Descriptive and analytical statistics (t-test, Chi2 and exact of Fisher) were used. LPC incidence was calculated in both groups. In addition, RR, RAR and NNT were also calculated. The study population was 220 patients, 120 (54.5%) operated with JL and 100 (45.5%) with VL; with a mean age of 45.5 years; 130 (59.1%) women. Diagnoses at intake, type of surgical wound, surgical techniques, surgical time and hospital stay were similar in the study groups. We found no significant differences between groups in the comparative study and incidence of evisceration (p=0.8012) and hernia (p=0.7895). However, significant differences were observed in favor of JL regarding seroma (p=0.0312) and wound infection (p=0.013). In conclusion, JL is safe and comparable with respect to VL in terms of LPC in patients who underwent HAS.


Gislason, H.; Grønbech, J. E. & Søreide, O. Burst abdomen and incisional hernia after major gastrointestinal operations--comparison of three closure techniques. Eur. J. Surg., 161:349-54,1995.

Greenall, M. Y.; Evans, M. & Pollock, A. V. Midline or transverse laparotomy? A random controlled clinical trial. Br. J. Surg., 67:188-94, 1980.

Israelsson, L. A. & Millbourn, D. Prevention of incisional hernias: how to close a midline incision. Surg. Clin. North Am., 93:1027-40, 2013.

Le Huu Nho, R.; Mege, D.; Ouaïssi, M.; Sielezneff, I. & Sastre, B. Incidence and prevention of ventral incisional hernia. J. Visc. Surg., 149(5 Suppl):e3- 14, 2012.

Lillemoe, K. & Jarnagin, W. Master Techniques in Surgery: Hepatobiliary and Pancreatic Surgery. Disponible en books?id=NQNF81Ebn7sC&pg=PA232&lpg=PA232&dq=Incisi%C3%B3n+de+RioBran co& sou r ce=bl&o t s=P2D jpOCTo f&sig=Gh7_wve7Hr D2qUIItw aoe66ZWqc&hl=es&sa=X&ei= SZ6fU86_A-vQsQSrioDoAg&ved=0CEoQ6AEwBw#v=o nepage&q=Incisi%C3%B3n%20de%20Rio-Branco&f=false.

Manterola, C.; Muñoz, S.; Fernández, O.; Molina, E.& Barroso, M. Laparotomía en J: una vía de acceso opcional para cirugía abdominal alta. Rev. Chil. Cir., 51:275-82, 1999.

Seiler, C. M. & Diener, M. K. Which abdominal incisions predispose for incisional hernias? Chirurg., 81:186-91, 2010.

Wadström, J. & Gerdin, B. Closure of the abdominal wall; how and why? Clinical review. Acta Chir.Scand., 156:75-82, 1990.