Abdominal Incision Comparison Incision

Vertical Midline

Location
Sternal notch to symphysis pubis

Indications
Primary exposure of any part of the abdominal cavity

Advantages
Good exposure Easy hemostasis Fewer layers traversed

Disadvantages
Postoperative hernias above the umbilicus common Midline crossover vasculature is permanently altered Dehiscence and evisceration common Exposure is limited and it is difficult to extend

McBurney

Below the umbilicus through the McBurney point and extending toward the right flank

Open appendectomy

Lower Oblique Inguinal

Subcostal (Kocher)

Pubic tubercle to anterior iliac crest, above and parallel to the inguinal crease. May be extended for transplant, urologic, and vascular procedures Epigastrum extending laterally and obliquely downward to just below the costal margin

Open inguinal herniorrhaphy

Quick and easy to close with firm closure Less chance of postoperative herniation or disruption Does not disrupt any major abdominal arteries Good access to inguinal canal and related structures Good cosmetic results Minimal nerve damage Good exposure Strong incision

Open procedures of the gallbladder, biliary system, pancreas, and spleen Open gynecologic procedures, obstetric procedures

Superior epigastric artery may be sacrificed Lateral blood supply and innervation to the rectus muscle may be interrupted Painful

Pfannenstiel

Transverse, across the lower abdomen

Midabdominal Transverse

Slightly above or below the umbilicus extending laterally to the lumbar region at an angle between the ribs and iliac crest Midpoint between the xiphoid and umbilicus extending posteriorly across the 7th or 8th interspace and midcapsular line into the chest

Thoracoabdominal

Transverse colectomy or colostomy, choledochojejunostomy Surgery of the proximal stomach, distal esophagus, and anterior spine

Good exposure Strong scar Good cosmetic results Does not alter blood supply to abdominal wall if deep inferior epigastric artery is left intact Intercostal nerve preservation

Painful due to size and exposure required for procedure

Good exposure

Sacrifices the superior epigastric artery Painful due to size and exposure required for procedure