Subcostal gridiron incision for biliary surgery.

This retrospective study audited all the extrahepatic biliary operations performed through a subcostal muscle splitting incision between January, 1979 and June, 1995. Of the 400 patients subjected to biliary surgery 340 (85%) were females and 60 (15%) males. One hundred and eighty (45%) patients presented with symptoms of acute and 220 (55%) with chronic cholecystitis. Most (95%) of the operations were performed electively. Simple cholecystectomy was performed in 320 (80%) patients and 72 (18%) had common bile duct exploration for stones. Of these 67 had choledochoduodenostomy and 5 a polythene tube drainage of common bile duct. The overall morbidity of the procedure was 13.5% of which 3.5% were procedure related complications and 10.0% general complications. Only two deaths occured during the study giving a mortality of 0.5%. This technique has greatly reduced the hospital stay, the amount of blood loss during operation and post operative pain. No patient had incisional hernia or wound dehiscence and all the patients were back to work early. The results of this study suggest that this incision may be used with advantage elsewhere.