O &G Surgical Incisions

Question 1

Name 4 surgical incisions in O&G

Answer 1

• Lower segment Caesarean Section
• Laparotomy
• Abdominal (and VAGINAL) hysterectomy
• Laparoscopy

Question 2

What is often used to guide the incisions?

Answer 2

• Langer Lines
  (correspond to the Natural orientation of collagen fibres)
• generally parallel to the underlying muscle fibres

Question 3

What is a laparotomy?

Answer 3

• vertical midline incision made on the abdominal wall

Question 4

List the layers a laparotomy cuts through.

Answer 4

• Skin
• superficial fascia
• Rectus Sheath
• Rectus abdominus

Question 5

A surgical incision made on the flanks of the abdomen, cuts through what layers ?

Answer 5

Skin>Superficial Fascia>
>external oblique 
>Internal oblique
>tranversus abdominus 
> tranversalis fascia
> extra peritoneal fat 
> parietal peritoneum

Question 6

What are the ext. obliques attached to?

Answer 6

• btw the lower ribs (C7-10)and iliac crest, pubic tubercle and linea alba

Question 7

What is the linea alba?

Answer 7

• midline BLENDING of aponeuroses

- –fibres run in the same direction as external intercostals

Question 8

Where are the internal obliques attached?

Answer 8

• lower ribs, thoracolumbar fascia, iliac crest and linea alba

Question 9

Where is the transversus abdominus attached to?

Answer 9

• lower ribs, thoracolumbar fascia, iliac crest and linea alba

Question 10

What do the tendinous intersections do in the rectus abdominis?

Answer 10

• divides each rectus abdominis into 3/4 smaller muscles

- improves mechanical efficiency

Question 11

Where does the linea alba run from?

Answer 11

• xiphoid process to the pubic symphysis

Question 12

Where is the rectus sheath located?

Answer 12

• immediately DEEP to superficial fascia; surrounds the rectus abdominis m,

Question 13

What is the rectus sheath?

Answer 13

• combined aponeuroses of anterolateral abd. wall muscles;

- –Strong, fibrous layer

Question 14

Which incisions only requires the rectus sheath to be cut?

Answer 14

• Lower segment Caesarian section

Question 15

What is the clinical importance of the rectus sheath?

Answer 15

• being a strong, fibrous layer; when stitched closed after an operation; it increases the strength of the wound and REDUCES the risk of wound complications

Question 16

What complications may arise for not stitching the rectus sheath closed after an incision?

Answer 16

Incisional Hernia

Question 17

What is the nerve supply to anterolateral abdominal wall?

Answer 17

• 7th-11th Intercostal nerves aka thoracoabdominal nerves
• subcostal nerve (T12)
• iliohypogastric nerve (L1)
• ilioinguinal nerve (L1)

Question 18

How do nerves travel for the anterolateral abd. wall?

Answer 18

• enters from the Lateral Direction

- travels in plane between the internal oblique and transversus abdominis

Question 19

What is the blood supply to the anterolateral abdominal wall?

Answer 19

Anterior wall: Superior Epigastric
Inferior Epigastric arteries

Posterior wall supply:

• Intercostal and subcostal arteries
• continuation of posterior intercostal arteries

Question 20

How to incise muscle to ensure minimal damage ?

Answer 20

• incise in SAME direction as muscle fibre

- avoid damaging nerves and avoid interrupting blood supply

Question 21

Are the rectus muscles cut during LSCS incision?

Answer 21

NO

- they are separated from each other in a lateral direct

Question 22

What layers do you cut through with LSCS incision?

Answer 22

Skin and fascia
(anterior) Rectus sheath
Rectus abdominis – separate the muscles laterally
Fascia and peritoneum
Retract bladder (a urinary catheter is usually already inserted)
Uterine wall
Amniotic sac

Question 23

What layers are stitched together?

Answer 23

• uterine wall with visceral peritoneum
• rectus sheath
• –if high BMI; stitch fascial layer
• skin

Question 24

What layers are cut for laparotomy?

Answer 24

• skin and fascia
• LINEA alba
• peritoneum

Question 25

What is stitched closed in laparotomy?

Answer 25

• peritoneum and linea alba
• fascia
• skin

Question 26

A laparotomy is relatively BLOODLESS. What does this mean for the healing process?

Answer 26

• healing is not as good

- —incr. chances of wound complications —DEHISCENCE/ HERNIA

Question 27

Where are the incisions made in a laproscopy?

Answer 27

• usually a sub-umbilical incision is enough

- lateral ports can also be done—just AVOID inferior epigastric artery

Question 28

Name a maneouver that can help view pelvic organs easily.`

Answer 28

• grasping the cervix with forceps (inserted through the vagina)

Question 29

Describe the course of the inferior epigastric artery?

Answer 29

• emerges MEDIAL to DEEP inguinal ring (which is located half way btw the ASIS and pubic tubercle
• —then passes in a superomedial direction POSTERIOR to the rectus abdominus

Question 30

What is the diff. btw an abdominal hysterectomy and a vaginal hysterectomy?

Answer 30

• ABD. hyst.:removal of the uterus via an incision in the abdominal wall (same incision as LSCS)
• —vaginal- removal of the uterus via the VAGINA

Question 31

How to differentiate the ureter from the uterine artery?

Answer 31

• by the course of the ureter
• —the ureter passes inferior to the artery (“water under the bridge”)
• the ureter will VERMICULATE when touched (soft- to be filled)