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Kochers
Location/Direc tion
Oblique subscostal incision left or right
Description
Incision made obliquely in the epigastrium downward atleast 2 fingerbreadths below and parallel to the costal region or margin Incision in the epigastrium at the level of the xiphoid process then vertically downward to the level of the umbilicus
Advantage s
^Gives excellent exposure of the upper abdominal content ^Maximum postoperative strength ^Provides excellent exposure of upper abdominal content ^Easily executed ^Easily extended ^Easily closed ^Provides excellent exposure of the pelvic organs ^Quickly executed ^Extended easily ^Quickly used ^Allows maximum exposure of nearby organs according to the location ^Easily extended ^Gives firm
Disadvantage s
^External with difficulty ^Executed slowly ^Painful postoperatively
Uses
Right: ^Gall bladder and biliary tract surgery ^Liver surgery Left: ^Spleen surgery ^Gastric surgery
Synonym s
Subcostal
abdominal incision
^Rapid entry into the abdomen to control bleeding ulcer ^Gastric surgery ^Exploratory ^Pancreatic surgery ^Transverse colostomy
Incision made in the umbilicus and vertically extended downward in the midline to the suprapubic region
^Lacks strength
wound
^Pelvic laparotomy ^TAH-BSO ^Suprapubic prostatectomy ^Cystectomy ^Cystolithotomy ^CS ^Sigmoid colon operation Right upper: ^Gall bladder and biliary tract surgery ^Liver surgery Left Upper: ^Spleen surgery ^Gastric surgery ^Repair of hiatus hernia
Paramedian incision
Vertical incision that is confined to an area approximately 2 fingerbreaths to the right or left of the midline and maybe in the upper or lower
Incision is extended in a vertical direction parallel to & 2 fingers lateral to the midline rather
abdomen
closure
Mcburneys incision
Inguinal incision
Incision is extended obliquely from just below the umbilicus through the Mcburneys point upward toward the right flank Incision is extended from the pubic tubercle one fingerbreadth above and parallel to the inguinal crease up to the anterior iliac crest Incision is made at the lateral border of the rectus sheath at the level of the umbilicus and is extended out to the flank
to poor
Right Lower: ^Appendectomy ^Small bowel resection Left Lower: ^Sigmoid colon resection ^Hysterectomy Appendectomy
Gridiron incision
^Rapidly excuted and closed ^Easily extended ^Provides a secure wound ^Rapidly excuted and closed ^Easily extended ^Provides a secure wound
^Lumbar symphthectomy ^Nephrectomy ^Ureterolithotomy ^Inferior vena cava ligation ^Lumbar symphthectomy ^Nephrectomy ^Ureterolithotomy ^Inferior vena cava ligation Simple flank incision
Lumbotomy incision
Incision starts at the costovertebral angle and parallel to the 12th rib and extends forward and downward between iliac crest and the thorax
Thoracotomy Incision a. Right/Left Lateral posterothoracic Incision begins posteriorly inferior to the scapula and extends in oblique direction anteriorly over or between 2 ribs Incision is made from anterior midline or external border to the lateral mid-axillary line Left or right incision starts at point midway between xiphoid process and umbilicus and extends across the abdomento the 7th or 8th costal interspace and along interspace into the thorax Curved, transverse incision across the lower abdomen within the hairline of the pubis A curvilinear incision located below the umbilicus Cuvilinear incision 1 fingerbreadth ^Lung operation ^Anterior spinal fusion (thoracic vertebrae)
b.
Anterolateral approach
Injury to intercostals neurovascular bundle may result to: ^Postop pain ^Severe hemorrhage
^Lung operation ^Heart operation a. Ligation of patent ductus arteriosus b. Mitral commissuretomy ^Esophagectomy ^Esophagastrectomy ^Esophagocardiomyo tomy (Hellers procedure)
Thoracoabdominal incision
Pfannenstiel Incision
and with
Infraumbilical Incision
^Pelvic laparotomy ^TAH-BSO ^CS ^Prostate surgery ^Urinary bladder surgery Umbilical hernia repair
Bikini incision
Cuvilinear incision
b. c. d.
above the supraclavicular notch parallel to the lower insertions of the SCM muscle
Butterfly incision
Halstead incision
e.
f.
Cannine incision
fossa
Caldwell luc
g.
Gibson incision
Ureterolithotomy