Comparative Study of Postoperative Pain between Maylard Incision and Pfannenstiel Incision in Gynecologic Surgery: A Randomized Controlled Trial.

Background: Postoperative pain has many adverse effects for the patients with laparotomy operation. There are few studies that compare between Maylard and Pfannenstiel incision in term of pain and wound complication after operation.

Objective: To compare the postoperative pain and wound complications between the muscle-cutting Maylard incision and the Pfannenstiel incision in women who needed benign gynecologic surgery.

Material And Method: This randomized controlled trial study compared two laparotomy techniques, Maylard and Pfannenstiel method. Ninety cases of benign gynecologic conditions were recruited and randomly assigned to receive either Maylard or Pfannenstiel incision from August 2014 to October2015 at Thammasat University Hospital, Thailand. Visual analogue scale (VAS) was applied to measure postoperative pain. Baseline characteristics of the study groups and postoperative outcomes were analyzed.

Results: From the planned 90 recruited cases, there were 81 cases for complete analysis, 41 in Maylard and 40 in Pfannenstiel group. There were no difference in age, body mass index, education level, previous abdominal surgery and type of operation between Maylard and Pfannenstiel group. Duration of operation, type of anesthesia and dosage of analgesic drug were not statistically significant between both groups. Length of surgical wound was longer in Maylard than in Pfannenstiel group (17.27±0.6 vs. 14.13±0.8 cm, p = 0.04). Postoperative pain score (VAS) at 3, 6, 12, 24 and 48 hours were not statistically different between two groups. Pain score at 72 hours and 7th day in Maylard group showed significantly less than in Pfannenstiel group (0.51±0.5 vs. 1.10±1.0 p = 0.04, 0.12±0.3 vs. 0.23±0.4, p = 0.01, respectively). The numbers of participants with moderate to severe pain (VAS >4) in Maylard group were less than in Pfannenstiel group at 3, 6, 12 and 24 hours but after that there was no statistically difference. There were no postoperative wound complications such as disruption, infection or hematoma in all participants in this study.

Conclusion: Postoperative pain up to 48 hours in both Maylard and Pfannenstiel group showed similar VAS but after 48 hours; the Maylard group showed less pain. Even though the surgical wound length in Maylard group was longer than Pfannenstiel group, numbers of cases with VAS >4 within 24 hours in Maylard were less than in Pfannenstiel group. Postoperative pain up to 48 hours in both Maylard and Pfannenstiel group showed similar VAS but after 48 hours; the Maylard group showed less pain. Even though the surgical wound length in Maylard group was longer than Pfannenstiel group, numbers of cases with VAS >4 within 24 hours in Maylard were less than in Pfannenstiel group.