Maylard versus Cherney incision for gynecologic surgery: A triple blind clinical controlled trial

Abstract

Gynecological surgeries are one of the most common surgeries. Incision choice for surgery depends on several factors, including surgeon preference and skill, patient preference, surgical indication, underlying pathology, diagnosis of or suspected malignancy, previous surgical scar, and comorbid comorbidities. The present study compared Maylard incision with Cherney incision in gynecological surgeries. Materials and Methods: In this triple-blind clinical trial study, women undergoing hysterectomy for benign reasons were included in the study for one year from February 2017. Both incisions' surgical procedures and procedures were performed with the same technique in each group. A faculty surgeon with an assistant performed all surgeries. All patients underwent standard general anesthesia. After Maylard and Cherney incisions in the abdominal wall, the hysterectomy procedure was continued as standard. Intraoperative variables, including the duration of surgical incision to enter the abdominal cavity, the volume of bleeding and the duration of surgery, were mentioned in the operation description form. In addition, the postoperative abdominal distance was assessed. Postoperative pain was measured with the VAS scale and postoperative analgesic use. Patients' characteristics, including age, gravid, parity and previous surgical history, were recorded. Patients underwent monthly follow-up on day ten after surgery and then for up to three months after surgery, and complications included wound complications (hematoma, infection, wound opening), incisional hernia, postoperative pain, and readmission. Results: Sixty patients who were candidates for elective gynecological surgeries in the Maylard incision and Cherney incision groups were evaluated. The mean age of the patients was 46.72 years. The most common history of previous abdominal surgery in patients was TAH and then the cesarean section with a frequency of 31.7% and 28.3%, respectively. The most common surgical indication in the patients studied in the present study was related to AUB with a frequency of 48.3%. There was no difference between Maylard and Cherney incisions in terms of total surgery time; However, the bleeding volume in the Maylard incision group patients was significantly higher than Cherney (506.66 ml vs 429.31 ml; p = 0.031). The comparison of hemoglobin concentration after surgery in the studied patients was not statistically significant, but the hemoglobin level was lower in Maylard patients. Significantly, the patients' pain intensity in both groups decreased after three days, and on the other hand, the pain intensity was significantly higher in the Cherney incision group than in the Maylard incision group at all follow-up times. Also, in the present study, the mean number of analgesic drug doses in patients in the Maylard incision group was significantly lower than Cherney (2.83 vs 4.06; p = 0.001).