Surgical Incisions
Midline incision
Advantages
Bloodless approach
Fibrous tissue only
Quick access
Minimal restriction
Good if further laparotomies required
E.g. Crohn's patients
Swift closure
No need to close in layers
Disadvantages
Big Scar
Very painful post-op
Higher risk of wound breakdown
Uses
Emergency lapartotomy
Almost all abdominal operations where full access is required
Paramedian incision
Uses
Access to specific half of abdomen
Advantages
Access to lateral structures
E.g. kidneys
Separate incision in posterior rectus allows buttressing of wound
Reduces chance of herniation
Disadvantages
More time
Interrupts vessels and nerves
Atrophy of muscles medial to incision
Gridiron/ Lanz Approach to the appendix
Transverse incision
Uses
Ascending and/or descending colon
Duodenum
Pancreas
Advantages
Less painful
Better cosmetic results
No degeneration of rectus abdominis
Reduced herniation chances compared to midline
Disadvantages
Less exposure
Slower access
Obstructs appropriate site for stoma formation
Subcostal incision
Uses
Biliary surgery on the right
Spleen surgery on the left
Advantages
Less painful than midline
Good access to inferior surface of the liver
Disadvantages
Less exposure
Must be closed in layers
Advantages
Layered closure
Strong wound
Good access to appendix and caecum
Disadvantages
Potential damage to ilioinguinal and iliohypogastric nerves
Limited specific access
Uses
Appendectomy on right
Descending and/or sigmoid on left
Pfannestiel incisions
Uses
Access to pelvic viscera
C-sections and hysterectomies
Advantages
Unlikely to interrupt nervous supply
Easily hidden
Minimal scarring
Disadvantages
Bladder damage
Poor access to abdominal viscera
Thoraco-abdominal incisions
Abdominoplasty
Mercedes incision
Nephrectomy incision
Laproscopic incision