Surgical Incisions - abdomen

Question 1

Midline

Answer 1

• upper, middle or lower
• quick and easy, good access
• painful and cosmetic issue
• prone to hernias

Question 2

Paramedian

Answer 2

• vertical, lies on either side of midline
• access to lateral structures of the abdomen
• difficult to access contralateral structures
• muscles are split e.g. rectus and can atrophy

Question 3

Transverse

Answer 3

• less painful, heal well and good cosmesis
• time consuming and access can be difficult
• e.g. open AAA

Question 4

RUQ -
Kocher’s incision
Rooftop incision
Mercedes Benz Rooftop incision

Answer 4

• usually for open cholecystectomy or other biliary surgery
• less common today bc laparoscopic is more common
• one modification of kocher is a rooftop incision across whole upper abdomen (RUQ and LUQ) - used in upper GI and liver surgery
• also mercedes-benz rooftop procedures (rooftop with vertical extension into chest) - classically used for liver transplant

Question 5

Giridon / Lanz incision

Answer 5

• incision over Mc burney’s point (LLQ)
• giridon is oblique and lanz is transverse
• open appendicectomy
• less used due to increase of laparoscopy

Question 6

Rutherford-Morrison

Answer 6

• LLQ - oblique muscle cutting
• extension of giridon
• used to access caecum
• also used for pre peritoneal approach to great vessels or kindey
• variation to this is the high approach to femoral hernia (usually emergency)

Question 7

Pfannenstiel incision

Answer 7

• transverse suprapubic incision
• c-section
• pelvic surgery (orthopaedic fixation in pelvic trauma)
• prostate surgery

Question 8

Groin incisions

Answer 8

• oblique and above the groin usually indicate inguinal hernia repair
• vertical incision crossing the groin crease for vascular procedures e.g. bypass or femoral endarterectomy

Question 9

What to do when seeing an abdominal scar?

Answer 9

• ask the patient about it

- ask the patient to cough or get them to raise the legs off the bed to see if there any incisional hernia