Abdominal Incisions

Ideal Incision
The ideal incision should have the following characteristics:

Easy to open

Minimise damage to tissues

Avoid cutting nerves

Split rather than transect muscles

Limit damage to fascia

Easy to close

Allow sufficiently strong closure

Allow sufficient access

Extendable if necessary

Factors to Consider

Type of surgery

Target organ

Body habitus

Previous operations

Speed

Operator preference/experience

Types of Incision
Midline
This is one of the most common and versatile incisions for abdominal surgery, allowing
access to virtually all of the abdominal organs and theretroperitoneum, if necessary. After
the skin and subcutaneous tisuses are incised, the linea alba is opened. The advantage of
this incision is that the linea alba is relatively avascular and avoids damage to any muscles
or nerves. It is easy to extendable superiorly towards thexiphisternum, and, inferiorly,
towards the pubic bone. The linea alba and rectus sheath are strong enough to allow secure
closure

Transverse

Skin incision crosses fewer dermatomes

Subcostal
Also known as Kocher's incision. This can be right subcostal, used mainly for open
cholecystectomy, or left subcostal, used mainly forsplenectomy. A combination of both is
called a roof-top incision, useful in gastric and hepatopancreatobiliary surgery. When
extended up the midline (as may be required to implant a liver, for example) this incision
may be called a Mercedes-Benz incision for its resemblance to the company's logo.

Right iliac fossa

This incision is used mainly to perform an appendicectomy, although it can be used to gain
access to perform caecal decompression,appendicostomy and caecostomy.
Various eponymous incisions exist:

McBurney's incision - 1/3 of the way along the line from the anterior superior iliac
spine to the umbilicus

Lanz incision

Pfannenstiel

For Caesarian sections and urological surgery.