Abdominal incisions

A simple guide for nurses

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

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

Abdominal Incisions:-
Incisions for various laparotomy procedure

Types:-

I) Vertical Incisions:-
II) Horizontal Incisions:-
III) Transverse Incisions:-

Para → Side
Median → Midline

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(i) Vertical Incision

(ii) Horizontal Incision

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(i) Transverse Incision

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

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

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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.

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Layers to open:-
™ Skin
™ Subcutaneous fat
™ Anterior Rectus abdominis
™ Rectus sheath
™ Posterior Rectus Umblicus
™ External Peritoneum
™ Peritoneum

Procedure:-
(i) Total Abdominal Hystrectomy
(ii) LSCS (Lower Segment Cesarian Section)
(iii) Sulphingo Oophrectomy
(iv) Cystostomy
(v) 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

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 ™ External oblique muscle
™ Internal oblique apponeurosis
™ Transverse abdominis
™ External Peritoneum
™ Peritoneoum

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

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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

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 ™ 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 Kocher’s Incision:-
Definition:-
Making incision just bleow the lower rib on right side of abdomen
is called Rt. Subcoastal incision (or) Kocher’s Incision.

Layer’s 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 Partial Heptectomy
™ Liver Surgery
™ Bilary Externic anastomosis Tumor excessive

Advantages:-
™ Easy accessibility
™ Easily extensibility
™ Restriction of Diaphragm movement because to basal
peritonitis.

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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

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 ™ External Peritoneum
™ Peritoneoum

Procedure:-
™ Liver Transplant
™ Pancreatic Transplant
™ Whipple’s 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
™ Whipple’s Procedures
™ Abdominal Aortic Surgery

Advantages:-
™ Easy accessibility
™ Good Visualization
™ Wide working space

Disadvantages:-
™ Bleeding will be more

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 ™ 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

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 ™ 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 ē 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. Burney’s Incision”:-

Definition:-
Making incision on Mc. Burney’s Point (Mc. Burney’s poiont is
cutting the layer. Lateral ½ and medally 2/3 i.e from umbilical and far
lateral ½ 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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