Você está na página 1de 22

Abdominal incision

Bryan Dennis Bogar


1. Equivocal Incision
• When confronted with an
undiagnosed non-traumatic “acute
abdomen”
• The right paramedian area is selected
and not the left because conditions
that can cause acute abdomen, and
that may be difficult to diagnose
preoperatively are on the right side
of the abdomen.
• Ex : liver abscess, inflammatory
biliary tract disease, perforated
duodenal ulcer, Meckel’s
diverticulitis, ileal typhoid
perforation, mesenteric
lymphadenitis, and appendicitis.
2. Inguinal Incision
• This is the standard incision for
inguinal herniorrhaphy.
3. Bucket Handle Incision
• This incision was very popular
in preparing a kidney recipient
for transplantation.
(i) Vagotomy and pyloroplasty
(ii) Splenectomy
(iii) Appendectomy
(iv) bilateral nephrectomy
(v) Oophorepexy in females
4. Left Subcostal Incision
• This is ideal for an elective splenectomy especially
if the spleen is very enlarged as in cases of tropical
splenomegaly syndrome and in Hassab’s operation
for oesophageal varices
• Easy access to the upper part of the stomach and
intraabdominal oesophagus.
5. Marwedel Incision
• This incision gives good
access to the liver especially
the left lobe, stomach,
spleen, hepatic flexure,
splenic flexure and
transverse colon.
• problem : that the “T”
junction may not heal
properly initially.
6. Bevan Incision
• This incision serves a
similar purpose as
Marwedel incision
7. Right Subcostal Incision
(Kocher’s) incision
• This is a very popular
incision for biliary
tract surgery
especially for
cholecystectomy.
8. Kehr Incision
• This incision is more
suitable than Kocher’s
incision when biliary tract
anastomosis is desired.
• This incision ideal for
choledocho-duodenostomy,
choledochojejunostomy,
and cholecysto-
jejunostomy.
9. Mayo-Robson Incision
• This is also regarded as
a “hockey stick”
incision.
• Reverse of the Kehr
incision
10. Masson Incision
• This incision serves the
same purpose as Mayo-
Robson and Kehr
incisions.
• In this case the rectus
abdominal muscle may
have to be cut in a
diagonal manner.
11. McBurney Incision
• This is one of the earliest
incisions for appendicitis
• It is also referred to as
“Grid iron” incision.
• It is a popular incision
for appendicitis.
12. Transverse or Davis-Rockey
Incision
• This transverse incision
is preferred by many for
the removal of appendix
because it gives a better
cosmeticscar on healing
and the incision can
easily be extended
medially during surgery
if needed.
13. Battle-Jalaquier- Kammerer-
Lennander Incision
• This is usually referred to as
Battle incision for short.
• It is a lower right paramedian
incision but placed more
laterally than the standard
paramedian incision.
• It is suitable for dealing with
acute appendicitis and
pathologies in the right lower
quadrant of the abdomen.
14. Pfannenstiel Incision
• This is a popular
incision in
gynaecological pelvic
surgery.
• Good cosmetic effect.
• It is also suitable for
prostatic surgery in
men.
15. Thoraco-abdominal Incision
• Any of the appropriate upper abdominal incision
can be combined with a thoracotomy incision to
form a thoraco-abdominal incision.
• This is ideal for surgery of the lower oesophagus,
surgery of the cardiac portion of the stomach and
resection of lower oesophagus.
16. Chevron Incision (Roof Top
Incision)
• The incision may be
continued across the
midline into a double
Kocher incision or roof top
approach
• Ex : gastrectomy, operations
for renovascular
hypertension, total
oesophagectomy, liver
transplantation, extensive
hepatic resections, and
bilateral adrenalectomy
17. The Mercedes Benz
Modification
• Variant of this incision
consists of bilateral low
Kocher’s incision with an
upper midline limb up to and
through the xiphisternum.
• This gives excellent access to
the upper abdominal viscera
and, in particular to all the
diaphragmatic hiatuses
18. Midline Incision
• Almost all operations in the
abdomen and
retroperitoneum can be
performed through this
universally acceptable
incision
• Advantages:
1. It is almost bloodless
2. no muscle fibres are divided,
3. no nerves are injured,
4. It affords goods access to the upper abdominal
viscera,
5. It is very quick to make as well as to close; it is
unsurpassed when speed is essential
6. a midline epigastric incision also can be extended the
full length of the abdomen curving around the
umbilical scar
19. Lumbotomy incision
• This incision approach the
kidney, renal pelvis and upper
ureter to be accomplished more
rapidly with reasonably good
exposure and diminished
morbidity, particularly in selected
patients.
• The incision is particularly well
suited for bilateral nephrectomy
in renal transplantation, open
renal biopsy, simple
nephrectomy, pyelolithotomy,
pyeloplasty and upper third
ureterolithotomy
Thank You