Escolar Documentos
Profissional Documentos
Cultura Documentos
AND
COMPLICATIONS
o 2 vertical muscles
• Rectus abdominis
• Pyramidalis
Comparison of upper and lower three-fourths of
anterior abdominal wall
Upper Midline Lower Midline
Aponeurosis of Aponeurosis of
external oblique external oblique
weak or absent strong and well
developed
ANATOMY
LANGER’s LINE
• Also called CLEAVAGE LINE,
the direction within the
human skin along which the
skin has the least flexibility.
These lines correspond to the
alignment of collagen fibers
within the dermis.
• Incisions made parallel to
Langer's lines may heal better
and produce less scarring
than those that cut across.
CHOOSING THE INCISION
The choice of laparotomy incision
depends on :
• the area that needs to be
exposed,
• the elective or emergency
nature of the operation and,
• personal preference.
• Type of incision may however
have its influence on the
occurrence of post-operative
wound complications.
ELIS PRINCIPLES
• ACCESEBILITY
• EXTENSEBILITY
• SECURITY
COSMESIS
Prof. Harold Elis (1926- )
“Pray before surgery, but
remember this: GOD will not
alter a faulty incision.”
Keeney’s Dictum
Abdominal & Pelvic incisions
Vertical
Transverse & Oblique Incisions
Incisions Abdominothoracic Incisions
ADVANTAGE :
• Very quick to make & close
• Almost bloodles
• No muscle fibers devided
• No nerves are injured
• Extendable
EMERGENCY LAPAROTOMIES,
COLONIC RESECTION, MILES’ PROCEDURE
• UPPER MIDLINE ABDOMINAL INCISION
Hiatal hernia, esophagus, stomach, liver,
gallbladder, spleen
• LOWER MIDLINE ABDOMINAL INCISION
Sygmoid, colon, pelvic organs.
EXTENDED MIDLINE INCISION
MIDLINE INCISION
DISADVENTAGES
• The incision is “non anatomic”. It cuts across
the apponeurotic fibers, as oppose to
transverse incision which cut paralel to the
fiber.
• Contraction of the abdominal wall causes
laterally directed tension on the closure
suture material cut through by separation of
the transversely oriented fibers.
• More chance of incisional hernia, less cosmesis
• The rate of dehiscence is higher.
COMPARISON OF
VERTICAL AND TRANSVERSE INCISION
VERTICAL INCISION
PARAMEDIAN INCISION
• It is made 2-5cm lateral to
umbilicus.
• Provided acces to lateral.
DISADVANTAGES :
• Comparatively more bleeding.
• Difficult to extent superiorly.
• It doesn’t give good acces to
contralateral structure.
• Atrophy of muscle medial to
the incision.
Paramedian Incision
VERTICAL INCISION
Pararectus Incision (Kammerer-Battle)
VERTICAL INCISION
MIDRECTUS INCISION
TRANSVERSE INCISION
ADVANTAGES
- best cosmetic results
- less painful-faster healing postoperative
- greater strength
DISADVANTAGES
- more time-consuming
- more haemorrhagic
- compromised ability to explore upper abdominal
cavity
- division of multiple layers of fascia and muscleand
nerves, may result with haematoma or seroma in
potential spaces.
TRANSVERSE INCISION
KOCHER INCISION
-Intra-abd.abscess - hernia
-Cannula phlebitis
- UTI
COMPLICATION
FEVER AFTER GI SURGERY
COMPLICATION
SURGICAL SITE INFECTION
COMPLICATION
BURST ABDOMEN
• Partial or complete post
operative separation of an
abdominal wound closure with
protrusion or evisceration of
the abdominal contents
• Most commonly occurs
from the POD #5-8 when
the strength of wound is at
its weakest
• Usually sutures opposing the
deep layers, i.e, peritoneum
and rectus sheath tear through
causing burst abdomen
COMPLICATION
INCISIONAL HERNIA
COMPLICATION
INTESTINAL ADHESION
From every wound there is a scar,
and every scar tells a story.
A story that says,
“ I have survived”.
THANK YOU