Transcript ABDOMINAL INCISIONS

ABDOMINAL INCISIONS
A cut produced surgically by a sharp instrument
that creates an opening into the abdomen
When choosing an incision these three should be
achieved:
Accessibility
Extensibility
Security
Re-entry into the abdominal cavity is best done
through the previous laparotomy incision. This
minimizes further loss of tensile strength of the
abdominal wall by avoiding the creation of
additional fascial defects
 CLASSIFICATIONS:
 Vertical incision
 Midline incisions
 Paramedian incisions
 Transverse and oblique incisions
 Kocher's subcostal Incision
 Chevron (roof top Modification )
 Mercedes Benz Modification
 Mc Burney’s grid iron or muscle splitting incision.
 Rutherford morison incision
 Pfannenstiel incision
 Maylard Transverse Muscle cutting Incision
 Transverse muscle dividing incision
 Thoracoabdominal incisions.
 MIDLINE

-the
most common incision
 three types:
 Upper Midline Incision
 From xiphoid to above umbilicus.
 Skin  superficial and deep fascia  linea alba  extraperitoneal fat  peritonium.
 Lower Midline Incision
 From the SUPERIOR umbilicus to INFERIOR pubic symphysis .
 Full Midline Incision
 From xiphoid to pubic symphysis inferiorly.

Advantages:

Adequate exposure of most if not all of the abdominal viscera
 It is almost bloodless.
 No muscle fibers are divided.
 No nerves are injured.
 It is very quick to make as well as to close.
 Disadvantages:
 Extensive is difficult
 More painful.
 Chest complications.
 Wound infection, Ugly scar, Incisional hernia, etc.
 PARAMEDIAN
 2 to 5 cm lateral to the midline.
 skin  fascia  anterior rectus sheath  The posterior rectus sheath or
transversalis fascia  extraperitoneal fat and peritoneum are then excised
allowing entry to the abdominal cavity
 Advantages
 Provide an access to the lateral structure such as the spleen or the kidney
 The closure is theoretically more secure because the rectus muscle can act
as a support between the reapproximated posterior and anterior fascial
planes so lower risk of dehiscence and hernia as compared to midline
incision
 Disadvantages
 Takes longer to make and close
 results in atrophy of the muscle medial to the incision
 The incision is laborious and difficult to extend superiorly as is limited by
costal margin.
 Risk of epigastric vessels injury
TRANSVERSE AND OBLIQUE INCISIONS
 KOCHER ‘S INCISION
 Incision parallel to the right costal margin. started at the midline, 2 to 5 cm below the xiphoid and
extends downwards, outwards and parallel to and about 2.5 cm below the costal margin
 It shows excellent exposure to the gallbladder and biliary tract and can be made on the left side to show
access to the spleen.
 CHEVRON (ROOF TOP)MODIFICATION
 The incision may be continued across the midline into a double Kocher incision or roof top approach
which provide excellent access to the upper abdomen particularly in those with a
 broad costal margin
 MERCEDEZ BENZ
 consists of bilateral low Kocher’s incision with an upper midline incision up to the xiphisternum.
 MCBURNEY GRID IRON
 Made at the junction of the middle third and outer thirds of a line running from the umbilicus to the
anterior superior iliac spine. (The McBurney Point)
 RUTHERFORD-MORRISON INCISION
 This is extension of the McBurney incision by division of the oblique fossa
 PFANNESTIEL INCISIONP (smile incision)
 Used frequently by gynecologists and urologists for access to the pelvis organs,
bladder, prostate and for caesarean section.
 Usually 12 cm long and made in a skin fold approximately 5 cm above symphysis
pubis.
 skin  fascia  anterior rectus sheath  rectus muscle  transversalis fascia 
extraperitoneal fat  perineum.
 A convex incision which minimizing muscle parasthesia and paralysis postoperatively. It also follows the cleavage lines in the skin resulting in less scarring
 The incision offers Excellent cosmetic results because the scar is almost always
hidden by the pubic hair
 Limited exposure of the abdominal organs. Use of incision is therefore restricted to
the pelvic organs
 High risk of injury to the bladder
 Extension of the incision is difficult laterally
MAYLARD TRANSVERSE MUSCLE CUTTING
INCISION
It is placed above but parallel to the traditional
placement of Pfannenstiel incision.
Gives excellent exposure of the pelvic organs.
TRANSVERSE MUSCLE DIVIDING INCISION
The operative technique used to make such an
incision is similar to that for the Kocher incision. In
newborns and infants, this incision is preferred.
Also in obese patients
 THORACOABDOMINAL INCISION
 Converts the pleural and peritoneal cavities into one
common cavity  excellent exposure.
 Left incision  Resection of the lower end of the
esophagus and proximal portion of the stomach.
 Right incision  elective and emergency hepatic
resections.
Midline
Vagotomy
Jejunostomy
Gastrectomy
Pancreatomy
Hysterectomy
Cystotomy
Cystectomy
Salphingo
oopherectomy
Para median
Right
Cholecystectomy
Pyroplasty
Left
Splenectomy
pancreadectomy
thoracoabdominal
Transverse & oblique
Kocher
Cholecystostomy
Heptectomy
chevron
Gastrectomy
Esophagectomy
Adrenalectomy
Mercedez benz
Liver transplant
Pancreatic transplant
McBurney
Appendectomy
Rutherford-morison
caecostomy or
sigmoid colostomy
Pfannestiel
Hepatic resections
SURGICAL PROCEDURES
Caesarean section
Hysterectomy
Prostatectomy
1-Kocher Incision: 2-Midline: 3-McBurney: 5-Lanz: 6-Paramedian:
7-Transverse: MUSCLE DIVIDING
8-Rutherford Morison: 9-PfannenstieL: