Suprapubic Transverse Incision With Rectus Release for Upper Peritoneal Access): A Novel Dual-Plane Technique for Abdominal Wall Incision in Complex Gynecological Surgery

N/ANot Yet RecruitingNCT07373886

Cairo University50 enrolled

Overview

This study aims to evaluate the clinical effectiveness, anatomical benefits, and postoperative outcomes of the STIRRUP incision (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal Access) by comparing outcomes with historically established benchmarks and published data from traditional abdominal wall incisions used in complex gynecologic surgery.

Study Type

INTERVENTIONAL

Allocation

Purpose

PREVENTION

Masking

NONE

Enrollment

Conditions

Post-Op Complication

Interventions

STIRRUP (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal access) techniquePROCEDURE

Skin incision: A low curvilinear transverse incision will be made 2-3 cm above the pubic symphysis, corresponding to the Pfannenstiel site. Subcutaneous dissection: The subcutaneous tissue will be elevated between Scarpa's fascia and the anterior rectus sheath for approximately 10-12 cm cephalad. Anterior rectus sheath incision: A transverse incision will be made in the anterior rectus sheath approximately 10-12 cm above the pubis, parallel to the skin incision. The linea alba will not be divided, thereby preserving midline fascial integrity. Rectus muscle separation: Beneath the fascial window, the rectus muscles will be separated bluntly at the midline, as in the Pfannenstiel approach, to expose the posterior sheath and peritoneum. No transection of muscle fibers will be performed. Peritoneal entry: The peritoneum will be opened sharply under direct vision.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Female patients aged 18-65 years 2. Indication for open gynecologic surgery for benign or borderline pelvic or abdominopelvic masses 3. Body Mass Index (BMI) ≥ 18 kg/m² 4. Willing and able to provide informed consent and attend follow-up 5. Mass size between 15-30 cm, which is considered optimal for the STIRRUP (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal access) technique due to the balance between exposure and minimal morbidity Exclusion Criteria: 1. Malignant tumors requiring upper abdominal visceral resection (liver, spleen, diaphragm) 2. Emergency surgery 3. Previous complex abdominal wall reconstruction with mesh 4. Contraindication to general anesthesia 5. Masses extending to the xiphisternum or measuring \>30 cm 6. Cases requiring supracolic omentectomy 7. Planned lymphadenectomy (especially if comprehensive para-aortic lymph node dissection is required ) 8. Supramesocolic tumor extension or malignant ovarian tumors requiring hepatic resections, splenectomy, and diaphragmatic resection 9. Severe comorbidities precluding elective surgery 10. Pregnancy 11. Previous extensive upper abdominal surgery

Outcomes

Primary Outcomes

Postoperative seroma formation

clinically detectable subcutaneous fluid collection at the incision site, confirmed clinically and/or by ultrasound when indicated.

Time frame: within the postoperative or follow-up period (6 months)

Data from ClinicalTrials.gov

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