Abdominal incisions

A simple guide for nurses

Prepared by:
Mr. Varghese. Y M.Sc., (N), II year Shanmuga College of Nursing Salem

Abdomen walls:(i) (ii) (iii) (iv) (v) Skin Subcutaneous fat Rectus sheath External peritoneal fat Peritoneum Anterior Rectus Abdominis Posterior

Abdominal Incisions:Incisions for various laparotomy procedure Types:I) Vertical Incisions:II) Horizontal Incisions:III) Transverse Incisions:Para Median Side Midline

(i) Vertical Incision

(ii) Horizontal Incision

(i)

Transverse Incision

Vertical Incisions:
(1) Supra Umblic Midline Incision (SUMI):Definition:Making incision above the Umblicus in midline of adomen.

Layers to Open: Skin Subcutaneous fat Anterior Rectus abdominis Rectus sheath Posterior Rectus Umblicus External Peritoneum Peritoneum

Procedure: Emergency Vagotomy / Gasterior : Jejunostomy Gatrectomy total (or) partial Pancreaolomy Dueodenectomy] Advantages: Easy to open because minimum midline layers. Less bleeding because of Avascular layers Fast to open Disadvantages: Weak layer because of incision hernia is common. Extensive is difficult, is not possible for removal of stemum.

(2) Infra Umblical Midline Incision (IUMI):Definition:Making incision below the umbilicus the middle of abdomen.

Layers to open: Skin Subcutaneous fat Anterior Rectus abdominis Rectus sheath Posterior Rectus Umblicus External Peritoneum Peritoneum Procedure:(i) (ii) (iii) (iv) (v) Total Abdominal Hystrectomy LSCS (Lower Segment Cesarian Section) Sulphingo Oophrectomy Cystostomy Cystecotomy

Advantages: Easy to open because of avascular line Less bleeding Fast to open Disadvantages: Weak layer because of incision hernia is common. Extension is difficult because of umbilicus.

(3) Right Para Median Incision (RPMI):Definition:Making incision on the Rt. Side of midline of abdomen. Layer to Open: Skin Subcutaneous fat (Anterior Rectus between rectus sheath) External oblique apponeurosis 7

 External oblique muscle Internal oblique apponeurosis Transverse abdominis External Peritoneum Peritoneoum

Procedure: Cholecystectomy. Choledochastomy (open a ---------------) Perforature Pyloroplasty closure (Perforature) i.e., Duodenal ulcer perforature closes

Advantages: Strong layers to no chances for incisional hernia. Entenstabilty is easy Disadvantages: Bleeding will be more Post-operative pain is sever, because of transverse nerve.

(4) Left Para Median Incision (LPMI):Definition:Making incision on the Lt. side of the Abdomen.

Layers to open: Skin Subcutaneous fat Anti Rectus

 Rectus sheath Posterior Rectus Exterior rectus External Peritoneum Peritoneoum Procedure: Spleenectomy Distal Pancreadectomy (removal body and tail of pancreas) Gastreotomy Fundaapplication Advantages: Strong layers to no chances for incisional hernia Extansibilty easy Disadvantages: Bleeding will be more Post operative pain is severe, because of transverse nerve

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Horizontal Incision
(1) Right Subcostal Incision (RSI) or Kochers Incision:Definition:Making incision just bleow the lower rib on right side of abdomen is called Rt. Subcoastal incision (or) Kochers Incision. Layers to Open: Skin Subcutaneous fat External Oblique apponeurosis External Oblique muscle Internal oblique muscle Transverse addominis External Peritoneum Peritoneoum

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Procedures: Cholecystostomy Liver Surgery Bilary Externic anastomosis Advantages: Easy accessibility Easily extensibility Restriction of Diaphragm movement because to basal peritonitis. Tumor excessive Partial Heptectomy

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(2) Left Subcoastal Incision (LSI):Definition:Making incision just below the last rib on the left side of abdomen.

Layers to open: Skin Subcutaneous fat External Oblique muscle Internal oblique muscle Transverse addominis External Peritoneum Peritoneoum

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Procedures: Spleenectomy Bilrth Surgery (Pastial Gastrectomy) Helle Myotomy ie. It is a condtion dilation of oesophagus called Achalasia Cardia Advantages: Easy accessibility Easy entenstabilty Disadvantages: Bleeding will be more. Post-operative pain will be more Restriction of Diaphragm movement. E.g: Basal Peritonitus

(3) "Roof Top Incision:Definition:Making incision just below the rib on both side of abdomen. Layers to open: Skin Subcutaneous fat Linea alba External Peritoneum Peritoneoum In Laterally: Skin Subcutaneous fat External Oblique muscle Internal oblique muscle Transverse addominis 14

 External Peritoneum Peritoneoum

Procedure: Liver Transplant Pancreatic Transplant Whipples Procedure (Radial Pancrea toduodenectomy for Carcinoma of hed of pancreas) Abdominal Aortic Surgery

Mercedes Benz Incision:Defintion:A combination of vertical and transverse making incision just below the lower rib on both side of abdomen with extension vertically in midline.

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After layers and procedures are some as Roof Top Incision. Procedures: Liver transplant Pancreatic Transplant Whipples Procedures Abdominal Aortic Surgery Advantages: Easy accessibility Good Visualization Wide working space Disadvantages: Bleeding will be more 16

 Severe post operative pain Restricted Diaphragm Long time consisting more.

(4) Right Inguinal Incision (or) Rt. Iliac Incision:Definition:Making incision just below the inguinal cannal (or) iliac hole on the Rt. Side of abdomen.

Layers to Open: Skin Subcotaneous Fat External Oblique Muscle

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 Internal Oblique Muscle External Opponeurosis Inguinal cannel. Procedures: Rt. Inguinal Hernia Surgery a) Hermotomy (Child) b) Hermorraphy (Adult) c) Hernioplasts (Old Age) Rt. Femoral Hernia Surgery Rt. Spermatic Cord Surgery a) Vas different b) Vesticular Artery c) Vesticular Vein Rt. Vericocelotomy Advantages: Easy accessibility No need to open peritoneal cavity Disadvantages: Nerve injury is very common. i.e. Common nerve get injury ilio hypagastric nerve, iliac ingunnal nerve Injury to spermatic cord for testis

(5) Left Inguinal (or) Iliac Incision:Definition:Making incision just below the iliac cannal (or) inguinal cannal on the Lt. side of abdomen. Layers to open same as Rt. Iliac incision. Procedure: Lt. Inguinal Surgery Lt. Femoral Hernia Surgery 18

 Lt. Spermatic Cord Surgery Lt. Vericocelectomy.

(6) Pfannenstiel Incision:Definition:Making incision just above iliac bone (or) Inguinal cannal on both side of abdomen.

Layers to Open: External Oblique Muscle Internal Oblique Muscle Transverse Abdmominis External Peritoneum Peritoneum Mid Line: Anti-Rectus Abdominas

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 Rectus Sheath Post-Rectus Abdominis External peritoneum Peritoneum Procedure: Lower Segment cesarian Segment (LSCS) Cystecotomy Total Abdominal hysterectomy Bilateral salphingo oophrectomy Cystostomy Advantages: Cosmatic Incision Pain will be more.

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Oblique Incision
(1) Right Oblique Incision:Definition:Making incision on abdomen obliquely from anterior abdominal wall to lateral abdominal wall at right side.

Layers to open: Skin Subcotaneous tissue External Oblique apponeurosis External Oblique Muscle Internal Oblique Muscle Peritoneum

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Procedure: Nephrectomy Urethrolithotomy (Removal of a calcius from Uterus i.e open and remove stone Advantages: More specific incision No need to open pesitoneum Disadvantages: Sever bleeding] Injury to pleura is common because it is near or caused pneumothorax. Less accessibility

(2) Left Oblique Incision:Definition:Making incision on abdomen obliquely from anterior abdominal wall to lateral wall to lateral abdominal wall at left side. Layers to Open: Skin Subcotaneous tissue External Oblique apponeurosis External Oblique Muscle Internal Oblique Muscle Peritoneum Advantages: More specific incision No need to open pesitoneum

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Disadvantages: Sever bleeding] Injury to pleura is common because it is near or caused pneumothorax. Less accessibility

(3) Mc. Burneys Incision:Definition:Making incision on Mc. Burneys Point (Mc. Burneys poiont is cutting the layer. Lateral and medally 2/3 i.e from umbilical and far lateral is anterior supra iliac spine. The spino umbilical line). Layers to open: Skin Subcotaneous tissue External Oblique apponeurosis External Oblique Muscle

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 Internal Oblique Muscle Transverse abdominis Peritoneum-again cut

Procedures: Appendectomy Drainage of appendicular abscers Caecostomy (open of caecum) Ilio Cacal Lymh biopsy Advantages: More specific incision Less bleeding because of cutting muscle Disadvantages: Less accessibility Ilio inguinal nerve will get injury then causes

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(4) Transverse Incision:Definition:Making small transverse incision any where in anterior abdominal wall.

Layers to open:It is depend upon the region like medical (or) lateral. Same as Roof Top Incision. Procedure: Emergency Colostomy (open of colon) Ileostomy Supra Public Cystostomy Advantages: Good accessibility or more specific incision. Disadvantages: Small incision injury to near by organ (or) structure.

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