1. ABDOMINAL INCISIONS

2. A cut produced surgically by a sharp instrument that creates an opening into the abdomen
When choosing an incision these three should be achieved:
Accessibility
Extensibility
Security
Re-entry into the abdominal cavity is best done through the previous laparotomy incision. This minimizes further loss of tensile strength of the abdominal wall by avoiding the creation of additional fascial defects

3. CLASSIFICATIONS: Vertical incision Midline incisions
Paramedian incisions
Transverse and oblique incisions
Kocher's subcostal Incision
Chevron (roof top Modification )
Mercedes Benz Modification
Mc Burney’s grid iron or muscle splitting incision.
Rutherford morison incision
Pfannenstiel incision
Maylard Transverse Muscle cutting Incision
Transverse muscle dividing incision
Thoracoabdominal incisions.

4. Upper Midline Incision
-the most common incision
three types:
Upper Midline Incision
From xiphoid to above umbilicus.
Skin  superficial and deep fascia  linea alba  extraperitoneal fat  peritonium.
Lower Midline Incision
From the SUPERIOR umbilicus to INFERIOR pubic symphysis .
Full Midline Incision
From xiphoid to pubic symphysis inferiorly.
Advantages:
Adequate exposure of most if not all of the abdominal viscera
It is almost bloodless.
No muscle fibers are divided.
No nerves are injured.
It is very quick to make as well as to close.
Disadvantages:
Extensive is difficult
More painful.
Chest complications.
Wound infection, Ugly scar, Incisional hernia, etc.

5. PARAMEDIAN Advantages Disadvantages 2 to 5 cm lateral to the midline.
skin  fascia  anterior rectus sheath    The posterior rectus sheath or transversalis fascia  extraperitoneal fat and peritoneum are then excised allowing entry to the abdominal cavity
Advantages
Provide an access to the lateral structure such as the spleen or the kidney
The closure is theoretically more secure because the rectus muscle can act as a support between the reapproximated posterior and anterior fascial planes so lower risk of dehiscence and hernia as compared to midline incision
Disadvantages
Takes longer to make and close
results in atrophy of the muscle medial to the incision
The incision is laborious and difficult to extend superiorly as is limited by costal margin.
Risk of epigastric vessels injury

6. TRANSVERSE AND OBLIQUE INCISIONS
KOCHER ‘S INCISION
Incision parallel to the right costal margin. started at the midline, 2 to 5 cm below the xiphoid and extends downwards, outwards and parallel to and about 2.5 cm below the costal margin
It shows excellent exposure to the gallbladder and biliary tract and can be made on the left side to show access to the spleen.
CHEVRON (ROOF TOP)MODIFICATION
The incision may be continued across the midline into a double Kocher incision or roof top approach which provide excellent access to the upper abdomen particularly in those with a
broad costal margin
MERCEDEZ BENZ
consists of bilateral low Kocher’s incision with an upper midline incision up to the xiphisternum.
MCBURNEY GRID IRON
Made at the junction of the middle third and outer thirds of a line running from the umbilicus to the anterior superior iliac spine. (The McBurney Point)
RUTHERFORD-MORRISON INCISION
This is extension of the McBurney incision by division of the oblique fossa

7. PFANNESTIEL INCISIONP (smile incision)
Used frequently by gynecologists and urologists for access to the pelvis organs, bladder, prostate and for caesarean section.
Usually 12 cm long and made in a skin fold approximately 5 cm above symphysis pubis.
skin  fascia  anterior rectus sheath  rectus muscle  transversalis fascia  extraperitoneal fat  perineum.
A convex incision which minimizing muscle parasthesia and paralysis post- operatively.  It also  follows the cleavage lines in the skin resulting in less scarring
The incision offers Excellent cosmetic results because the scar is almost always hidden by the pubic hair
Limited exposure of the abdominal organs. Use of incision is therefore restricted to the pelvic organs
High risk of injury to the bladder
Extension of the incision is difficult laterally

8. MAYLARD TRANSVERSE MUSCLE CUTTING INCISION
It is placed above but parallel to the traditional placement of Pfannenstiel incision.
Gives excellent exposure of the pelvic organs.
TRANSVERSE MUSCLE DIVIDING INCISION
The operative technique used to make such an incision is similar to that for the Kocher incision. In newborns and infants, this incision is preferred. Also in obese patients

9. THORACOABDOMINAL INCISION
Converts the pleural and peritoneal cavities into one common cavity  excellent exposure.
Left incision  Resection of the lower end of the esophagus and proximal portion of the stomach.
Right incision  elective and emergency hepatic resections.

10. SURGICAL PROCEDURES Vagotomy Jejunostomy Gastrectomy Pancreatomy
Midline
Para median
Transverse & oblique
thoracoabdominal
Vagotomy
Jejunostomy
Gastrectomy
Pancreatomy
Hysterectomy
Cystotomy
Cystectomy
Salphingo oopherectomy
Right
Cholecystectomy
Pyroplasty
Left
Splenectomy
pancreadectomy
Kocher
Cholecystostomy
Heptectomy
chevron
Esophagectomy
Adrenalectomy
Mercedez benz
Liver transplant
Pancreatic transplant
McBurney
Appendectomy
Rutherford-morison
caecostomy or
sigmoid colostomy
Pfannestiel
Caesarean section
Prostatectomy
Hepatic resections
SURGICAL PROCEDURES

11. 8-Rutherford Morison: 9-PfannenstieL:
1-Kocher Incision:  2-Midline: 3-McBurney: 5-Lanz: 6-Paramedian: 7-Transverse: MUSCLE DIVIDING
8-Rutherford Morison: 9-PfannenstieL: