Abdominal Incisions
Abdominal Incisions
Abdominal Incisions
Midline incision
Used for a wide array of abdominal surgery
Allows the majority of the abdominal viscera to be
accessed
Midline laparotomy can run anywhere from the xiphoid
process to the pubic symphysis, passing around the
umbilicus
Incision will cut through the skin, subcutaneous tissue,
and fascia, the linea alba and tranversalis fascia, and the
peritoneum before reaching the abdominal cavity.
Obtains significant exposure of the viscera, causes
minimal blood loss or nerve damage
Used for emergency procedures
PARAMEDIAN INCISION
An alternative for the standard midline incision
Access lateral viscera, such as the kidneys, the spleen,
and the adrenal glands
Incision runs 2-5cm away from the midline, cutting
through the skin, subcutaneous tissue, and the
anterior rectus sheath.
Avoids relatively avascular linea alba, and impaired
wound healing.
PARAMEDIAN INCISION
Pararectal incision (Battle)
Rectus sheath opened
Rectus muscle retracted medially
Extending of this incision may damage the segmental
nerve supply to the rectus muscle
Appendicectomy
TRANSVERSE INCISIONS
A supraumbilical transverse incision offers excellent
exposure of the upper abdomen.
In full-length transverse incision, the oblique,
transverse and rectus abdominis muscle and linea alba
are cut.
Infraumbilical transverse incision in the lower
abdomen is the Pfannenstiel incision, used for
gynaecological and obstetric procedures.
Skin is incised transversely, with convexity downward
to avoid dissection of blood vessels and nerves
OBLIQUE INCISION
Kocher incision
Subcostal incision, starting below xiphoid and extend
laterally
Access for gall bladder and/or biliary tree pathology
The incision run parallel to the costal margin
Starts below the xiphoid and extends laterally
Incision pass through
Rectus sheath and rectus muscle
Internal oblique and transversus abdominus
Transversalis fascia and peritoneum
OBLIQUE INCISION
Chevron / rooftop incision
Extension of the Kocher incision to the other side of the
abdomen.
Used for oesophagectomy, gastrectomy, bilateral
adrenalectomy, hepatic resections, liver transplantation
Mercedes Benz incision
Chevron incision with a vertical incision and break
through the xiphisternum
Used for same indications as the Chevron incision
Classically seen in liver transplantation
① Midline incision, ② Paramedian incision, ③ Kocher incision,
④ Rooftop modification and ⑤ Mercedes Benz modification.
OBLIQUE INCISION
Lanz and Gridiron incisions
Used to access the appendix, predominantly for
appendicetomies.
Both incisions are made at McBurney’s point – two-
thirds from the umbilicus to the ASIS
Pass through all the abdominal muscles, transversalis
fascia, and peritoneum
Lanz incision is a transverse incision, while Gridiron is
oblique (superolateral to inferomedial)
Lanz (transverse) and Gridiron (oblique) incisions at McBurney’s point.
OBLIQUE INCISION
Rutherford Morrison
This is an oblique muscle-cutting incision
Provide good access to the right or left colonic resection,
caecostomy or sigmoid colostomy.
Incision is deepened through subcutaneous tissues and
then through all three lateral muscle layers
Lower end over McBurney’s point and extend obliquely
upwards and laterally