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Tak et al. Mini-invasive Surg 2018;2:15 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.05

Original Article Open Access

Pfannenstiel vs. midline incision for urinary
diversion, following minimally invasive radical

cystectomy: single center experience

Gopal Ramdas Tak, Arvind P. Ganpule, Abhishek G. Singh, Aditya Pratap Singh Sengar, Mohankumar
Vijayakumar, Sudharsan S. Balaji, Ravindra B. Sabnis, Mahesh R. Desai

Department of Urology, Muljibhai Patel Urological Hospital (MPUH), Nadiad 387001, Gujarat, India.

Correspondence to: Dr. Gopal Ramdas Tak, Department of Urology, Muljibhai Patel Urological Hospital, Dr. V V Desai Road,
Nadiad 387001, Gujarat, India. E-mail: drgopaltak@gmail.com

How to cite this article: Tak GR, Ganpule AP, Singh AG, Sengar APS, Mohankumar V, Balaji SS, Sabnis RB, Desai MR. Pfannenstiel
vs. midline incision for urinary diversion, following minimally invasive radical cystectomy: single center experience. Mini-invasive
Surg 2018;2:15. http://dx.doi.org/10.20517/2574-1225.2018.05

Received: 26 Jan 2018 First Decision: 23 Mar 2018 Revised: 23 Apr 2018 Accepted: 8 May 2018 Published: 31 May 2018
Science Editor: Charles F. Bellows Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

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).

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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