Incision in the abdomen
An incision in the abdomen is an opening or a cut made by the surgeon. It is done to permit access to abdominal organs for surgery. The selection of an incision depends on
- Underlying condition prompting the surgery.
- Possibility of scar tissue formation.
- Comorbidities (other existing conditions).
Abdominal incisions are of three types:
- Transverse incision
- Vertical incision
- Oblique incision
Transverse incisions are of different types that include:
- Pfannenstiel incision: It is a curved incision that is approximately 10-15-cm long and 2 cm above the pubic symphysis (bikini line).
- Kustner incision: It involves a slightly curved skin incision that extends just below the pubic hairline (bikini line).
- Cherney incision: It involves a cross-section of the abdominal muscle at insertion in the pubic area.
- Maylard incision: It is a muscle-cutting incision 3-8 cm above the pelvic region in which all layers of the lower abdominal wall are penetrated and cut.
- Mouchel incision: It runs lower than a Maylard incision (runs at the upper limit of pubic hair).
- Joel-Cohen incision: It is mainly used for a hysterectomy and cesarean delivery (gynacological procedures).
Advantages of a transverse incision include:
- Less painful
- Greater strength
- Better cosmetic results
- Doesn’t interfere with postoperative respirations
Disadvantages of a transverse incision include:
- Can lead to hemorrhages
- Can lead to hematoma (collection of blood at the cut sight) or seroma (collection of fluid at the incision site)
- Restricts the exploration of the upper abdominal cavity
Types of a vertical incision include:
- Midline incision: The incision extends from the lower part of the breastbone down to the pelvic region.
- Paramedian incision: It runs 2-5 cm away from the midline incision.
Advantages of a vertical incision include:
- Excellent exposure
- Easily extendable
- Postoperative blood loss is less with midline incision
- Minimum nerve damage
- Easy entry into the abdomen and pelvis with a midline incision
Disadvantages of a vertical incision include:
- Mediocre cosmetic results
- Higher infection rates, operative time, and hemorrhage with a paramedian incision
- Wound dehiscence (separation of the edges of wounds) and hernia may be common
Oblique incisions are of two types:
- Gridiron incision: It is a muscle-splitting oblique incision made at the right lower part of the abdomen. It is used for appendectomy.
- Rockey-Davis incision: It is a crossover incision made at the right lower part of the abdomen. It is used for appendectomy.
Other types of incision include:
- Kocher’s incision: It is an incision made several inches below and parallel to the lower border of the front of the rib cage. It is useful for biliary tract surgery. There are two modifications of Kocher’s incision that include:
- Chevron/rooftop incision: It is the extension of a Kocher’s incision to the other side of the abdomen. It is useful for esophagectomy, gastrectomy, or liver transplantations.
- Mercedes Benz incision: It is the Chevron incision with a vertical incision extending up through the chest.
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