Sensory Impact of Bilateral Subcostal Incision in Long Term Survivors After Whipple Surgery

Background Whipple surgery needs adequate surgical exposure. The bilateral subcostal incision (BSI) is one of the traditional preferred approaches. However, the long-term sensory impairment following BSI in survivors has not been thoroughly investigated. Methods Out of 196 patients who underwent Whipple surgery with bilateral subcostal incision, 39 patients who completed 6 months follow up (median 43 months) were included in the study. The area of sensory impairment (SI) was measured using pin prick method and the Nottingham Sensory Assessment (NSA) scale and factors affecting the sensory impairment were evaluated. Factors influencing sensory impairment were analyzed, and correlations were determined Results The median age was of the cohort was 51 yrs (range 16-78 yrs) with 61% (n =23) being male. The median area of sensory loss was 109.27 cm ² and 97.3 % (n=36) had grade NSA 1/0 SI. In univariate analysis incision angle (p=0.050), length of the right limb (p = 0.019), Body mass index (p = 0.021) and distance from subcostal margin (p=0.029) had a significant association with SI. In multivariate analysis, the distance from the subcostal margin had a significant association (p=0.037) with SI and it showed a significant negative correlation. Conclusion There is a consistent area of sensory impairment in long-term survivors after Whipple surgery. This can potentially be minimized when an incision is placed furthest away from the subcostal margin.