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

Cairo University (CU)

Status: Not yet enrolling

Conditions: Post-Op Complication

Treatments: Procedure: STIRRUP (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal access) technique

Study type: Interventional

Funder types: Other

Identifiers

NCT07373886

MS-599-2025

Details and patient eligibility

About

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.

Enrollment: 50 estimated patients

Sex: Female

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Prevention

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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50 participants in 1 patient group

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

Experimental group

Description:

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.

Treatment:

Procedure: STIRRUP (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal access) technique