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

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.

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Key information

Conditions

Post-Op Complication Pathologic Processes Pathological Conditions, Signs and Symptoms Postoperative Complications

Age range

18 year–65 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Female patients aged 18-65 years
Indication for open gynecologic surgery for benign or borderline pelvic or abdominopelvic masses
Body Mass Index (BMI) ≥ 18 kg/m²
Willing and able to provide informed consent and attend follow-up
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

Malignant tumors requiring upper abdominal visceral resection (liver, spleen, diaphragm)
Emergency surgery
Previous complex abdominal wall reconstruction with mesh
Contraindication to general anesthesia
Masses extending to the xiphisternum or measuring >30 cm
Cases requiring supracolic omentectomy
Planned lymphadenectomy (especially if comprehensive para-aortic lymph node dissection is required )
Supramesocolic tumor extension or malignant ovarian tumors requiring hepatic resections, splenectomy, and diaphragmatic resection
Severe comorbidities precluding elective surgery
Pregnancy
Previous extensive upper abdominal surgery

Treatment and study plan

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

Procedure

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.

Primary outcomes

Postoperative seroma formation

Time frame: within the postoperative or follow-up period (6 months)

clinically detectable subcutaneous fluid collection at the incision site, confirmed clinically and/or by ultrasound when indicated.

Sponsors and collaborators

Lead sponsor

Cairo University

Other

Registry information

Important dates

Study start: 2026
Primary completion: 2026
Study completion: 2026
First posted: Jan 28, 2026
Registry last updated: Jan 28, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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