***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background We performed a r and omized study to evaluate the differences between upper midline incision and transverse incision for gastrectomy . Methods Patients undergoing distal gastrectomy or total gastrectomy for gastric cancer were r and omly allocated to have either an upper midline incision or a transverse incision . The times taken to open and close the abdominal cavity , the number of doses of postoperative analgesics , and the incidence of postoperative pneumonia , wound infection , and intestinal obstruction were compared between the patients having the two incisions . Results Times for both opening and closing the abdominal cavity were longer with a transverse incision , in both the distal gastrectomy group and total gastrectomy group . In the patients in whom continuous epidural analgesia was used postoperatively , the number of additional doses of analgesics was smaller in the transverse-incision group after distal gastrectomy . The incidence of postoperative pneumonia was lower in the transverse-incision group after distal gastrectomy . The number of patients with postoperative intestinal obstruction was smaller in the transverse-incision group than in the midline-incision group after distal gastrectomy . In contrast to distal gastrectomy , there was no significant difference in the number of doses of postoperative analgesics , incidence of postoperative pneumonia , or incidence of postoperative intestinal obstruction between the two study groups after total gastrectomy . Conclusion A transverse incision for distal gastrectomy may be more beneficial than an upper midline incision in attenuating postoperative wound pain , decreasing the incidence of postoperative pneumonia , and preventing postoperative intestinal obstruction Purpose Transverse and midline abdominal incisions are both commonly used for laparotomy to perform surgery on the pancreas and stomach , but comparative data are limited , especially from prospect i ve r and omized trials . Methods During a predefined 2-year recruitment period , 94 patients undergoing an elective major laparotomy for disorders of the pancreas or stomach were enrolled in this study . The outcome measures were pulmonary function , incisional pain , and wound characteristics . Results The operation groups were equally divided according to the type of incision used . The patients who underwent transverse incision laparotomy had significantly better postoperative pulmonary function and significantly less postoperative incisional pain than those who underwent midline incision laparotomy ( P < 0.05 ) , but there were no differences in morbidity and the incidence of wound complications . Conclusion Performing a transverse incision for surgery on the pancreas or stomach results in better postoperative pulmonary function and less incisional pain than a midline incision , without affecting postoperative morbidity OBJECTIVE The purpose of this prospect i ve r and omized study was to compare the left retroperitoneal approach ( RPA ) with the midline transperitoneal approach ( TPA ) for infrarenal abdominal aortic aneurysms ( AAAs ) repair with operative details , postoperative complications , and total cost comparision . MATERIAL AND METHOD Between January 2000 and December 2003 , 36 patients undergoing elective surgery for infrarenal AAAs were included in the prospect i ve comparison of transperitoneal approach ( TPA ) with retroperitoneal approach ( RPA ) .  Thirty-six patients were analyzed , with 18 in group 2 ( TPA ) and 18 in group I ( PRA ) . There was no significant differences between the groups in patient demographics . ( p value > 0.05 ) RESULTS There was no significant differences in the aortic cross clamp time , operative time , estimated blood loss and intraoperative blood transfusion between the two groups ( p value > 0.05 ) ; however , significantly more intraoperative fluid needs and bowel function onset had a statistically longer return in group 11 ( TPA ) than in group I ( RPA ) . Statistically reduction in postoperative ileus ( > 4 days ) and total length of hospital stay was observed in group I ( RPA ) ( p value < 0.05 ) . Postoperative cardiopulmonary complications were statistically significantly more increased in group II ( TPA ) than in group I ( RPA ) . Wound complications were more in group I ( RPA ) ( 1 hematoma , 4 abdominal wall hernia , and 4 chronic wound pain ) than in group II ( TPA ) ( 2 chronic wound pain ) . Total cost payment was not significantly different in both groups . CONCLUSION The left retroperitoneal approach for infrarenal AAAs repair , with fewer cardiopulmonary complications and shorter hospital stay has more unsatisfactory postoperative wound complications than the midline transperitoneal approach Two-hundred and nine patients were entered into a prospect i ve , r and omized trial in order to determine whether a vertical or transverse abdominal incision is the more satisfactory in producing sound wounds . Ninety-six patients were r and omized between paramedian and transverse incisions  , and followed up for at least 1 year . No significant difference in the incidence of wound failure could be shown between 46 paramedian and 50 transverse incisions . Those patients who were considered to require a vertical incision were r and omized between median and paramedian incisions . No significant difference in wound failure rates between 39 median and 40 paramedian incisions could be demonstrated . No advantage or disadvantage of a transverse over a vertical abdominal incision or of a paramedian over a median incision could be shown in this study In a series of 579 patients undergoing major laparotomy , the direction of incision ( midline or transverse/oblique muscle‐cutting ) was decided r and omly . The severity of postoperative pulmonary complications was expressed by a scoring system which allowed categorization into mild ( score 0–3 ) , moderate ( score 4–6 ) and serious ( score 7 or more ) complications Equal access to the abdominal aorta can be attained through midline and transverse abdominal incisions . The surgical literature suggests that transverse incisions cause less postoperative pain and morbidity .  Fifty patients ( 10 females and 40 males , mean age 67 years ) undergoing abdominal aortic surgery were r and omised to a midline ( n = 25 ) or transverse ( n = 25 ) incision . All patients were evaluated preoperatively and postoperatively for seven days . Changes in pulmonary function ( FVC and FEV1 ) , time to open and close the incision , analgesia used ( morphine mg/kg/h ) , clinical or X-ray evidence of chest infection , and the duration of ICU stay were recorded . In the transverse group there was a reduction in the incidence of chest complications ( 20 % vs. 28 % , p = ns ) and these incisions took longer to open ( 13.9 + /- 4.6 vs. 9.9 + /- 5.1 , p < 0.05 ) , but overall there was no significant difference between any other parameter in the two groups . Our results show no statistically significant difference in morbidity or analgesia consumption following transverse or midline abdominal incisions and we conclude that the type of incision used can be left to the surgeon 's preference A prospect i ve r and omized trial compared pain in the first 24 h after gallbladder surgery via an upper midline or a transverse incision .  Pain was measured by the patients ' self‐administered consumption of pethidine , degree of postoperative respiratory impairment and a visual analogue pain scale . The upper midline incision group self‐administered significantly more pethidine than the transverse incision group ( P<0–001 ) , but there was no difference between the groups in respiratory function or visual analogue pain scale results 24 h after operation . Length of hospital stay was not different . An upper midline incision is more painful  than a transverse incision in the first 24 h following gallbladder surgery OBJECTIVE To evaluate the impact of a st and ard vertical laparotomy versus a Pfannenstiel transverse laparotomy on intra- , peri-operative , and 6-month follow-up outcome in patients undergoing radical retropubic prostatectomy with pelvic lymphadenectomy with spinal anesthesia .  METHODS Between January 2003 and June 2003 , 69 age-matched consecutive patients with clinical ly localized prostate cancer underwent radical retropubic prostatectomy with pelvic lymphadenectomy with spinal anesthesia and were r and omized into Group 1  ( vertical laparotomy : 35 patients ) and Group 2  ( Pfannenstiel laparotomy : 34 patients ) . An extensive analysis of the critical intra- , peri-operative , and 6-month follow-up clinical parameters was performed . RESULTS Both the hemodynamics and the biochemical balance were not significantly different between the two groups . Overall blood loss ( p = 0.78 ) , autologous ( p = 0.88 ) and homologous ( p = 0.36 ) blood transfusions were similar regardless of the type of laparotomy .  Surgical time was not significantly ( p = 0.27 ) different between the two groups . Similarly , the two forms of laparotomy did not differ regarding the length of the surgical incision ( p = 0.21 ) , as measured at the end of the procedure . Post-operative oxygen saturation percentage by pulse oximetry , as well as post-op sedation score , were not significantly different ( p = 0.06 and p = 0.97 , respectively ) . Waiting time in the post-operative holding area ( p = 0.15 ) , and pain score in the post-operative holding area ( p = 0.9 ) as well as on post-operative day 1 ( p = 0.1 ) were not significantly different between the two groups . The rate of first flatus passage and of unassisted ambulation were similar regardless of the type of laparotomy during post-operative day day 1 . The two types of incision made it possible to remove a similar ( p = 0.34 ) number of pelvic lymph nodes and were associated to a similar rate of positive surgical margins among pT2 patients . At the 6-month follow-up the occurrence of a pelvic lymphocele and of deep venous thrombosis was similar in the two groups ( p = 0.6 and p = 0.16 , respectively ) . Complete urinary continence and spontaneous erectile function recovery was reported in a similar number of patients regardless of the type of surgical incision ( p = 0.59 and p = 0.40 , respectively ) . CONCLUSIONS These results suggest that a Pfannenstiel transverse suprapubic laparotomy does not result in a significantly different outcome from a st and ard vertical laparotomy in patients undergoing a radical retropubic prostatectomy with pelvic lymphadenectomy with L2-L3 spinal anesthesia for clinical ly localized prostate cancer We report the results of a prospect i ve and r and omized trial design ed to study the incidence of abdominal and pulmonary complications in gallstone surgery comparing subcostal ( SI ) with midline incision . The need for postoperative analgesia was lower in the SI group . There was no difference in the degree of hypoxaemia in the first two postoperative days , but there was less impairment of pulmonary function in terms of vital capacity and forced expiratory volume in 1 s ( P less than 0.0001 ) in the SI group . SI patients also had a lower incidence of pulmonary or abdominal complications but the difference was not significant . Finally , we found a reduced hospital stay for the SI patients ( P less than 0.01 ) , probably related to a reduced postoperative analgesic requirement and an improved pulmonary function . We conclude that subcostal incision is a better approach for biliary tract surgery and should be used whenever possible Five hundred and seventy‐nine patients undergoing major laparotomy  were r and omly allocated to have midline or transverse incisions . Transverse incisions took longer to make and caused more bleeding but ( in the absence of wound sepsis ) no transverse wound burst and there were only 2 incisional hernias . In the midline group , without wound sepsis , there were 2 burst abdomens and 9 incisional hernias Midline and transverse incision are commonly used in upper abdominal surgery . A comparison of the two procedures with respect to the respiratory function , assessed by spirometry , blood gas analysis , inspiratory and expiratory pressures , and thoraco-abdominal respiratory synchronism , was made in two groups of patients after surgery on the abdominal aorta . 32 patients affected by abdominal aortic obstructive or aneurysmatic disease , c and i date s for aortoiliac revascularization , were r and omized into two groups of 17 ( group A ) and 15 ( group B ) patients respectively . Group A underwent midline laparotomy and group B supraumbilical transverse laparotomy .  Ventilatory function and blood gas analysis were determined on the day before operation and on the second and eight postoperative day . All patients showed a depressed ventilatory function postoperatively , but the impairment was significantly minor after transverse laparotomy The objective of this r and omized trial was to evaluate the incidence of incisional hernia after transverse or vertical incisions for open aortic aneurysm repair Electrocautery is used increasingly for tissue dissection , although fears of excessive scarring and poor wound healing have curtailed its widespread use for skin incision . This study compared electrosurgical incision with traditional scalpel incision . The influence of the type of abdominal incision on post‐operative pain and pulmonary function was investigated in patients operated upon for a right‐sided cancer of the large bowel Abstract Objectives To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence ( NICE ) . Design Interrupted time series analysis , review of case notes , survey , and 
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Despite these limitations , and potentially significant biases related to method ological quality , there was evidence to suggest that a transverse or oblique incision may be less painful and have less impact on pulmonary function than a midline incision , particularly in the early postoperative period .
However , there was no difference seen in early or late postoperative complications between a transverse or oblique and a midline incision and recovery times were similar .
Both analgesia use and pulmonary compromise may be reduced with a transverse or oblique incision but this does not seem to be significant clinical ly as complication rates and recovery times are the same as with midline incision .