MIDLINE INCISION

 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