Abdominal incisions

Question 1

Midline incision

Answer 1

Commonest approach to the abdomen
Structures divided: linea alba, transversalis fascia, extraperitoneal fat, peritoneum (avoid falciform ligament above the umbilicus)
Bladder can be accessed via an extraperitoneal approach through the space of Retzius

Question 2

Paramedian incision

Answer 2

Parallel to the midline (about 3-4cm)
Structures divided/retracted: anterior rectus sheath, rectus (retracted), posterior rectus sheath, transversalis fascia, extraperitoneal fat, peritoneum
Incision is closed in layers

Question 3

Battle

Answer 3

Similar location to paramedian but rectus displaced medially (and thus denervated)
Now seldom used

Question 4

Kocher

Answer 4

Incision under right subcostal margin e.g. Cholecystectomy (open)

Question 5

Lanz

Answer 5

Incision in right iliac fossa e.g. Appendicectomy

Question 6

Gridiron

Answer 6

Oblique incision centered over McBurneys point- usually appendicectomy (less cosmetically acceptable than Lanz

Question 7

Gable

Answer 7

Rooftop incision

Question 8

Pfannenstiel’s

Answer 8

Transverse supra pubic, primarily used to access pelvic organs

Question 9

McEvedy’s

Answer 9

Groin incision e.g. Emergency repair strangulated femoral hernia

Question 10

Rutherford Morrison

Answer 10

Extraperitoneal approach to left or right lower quadrants. Gives excellent access to iliac vessels and is the approach of choice for first time renal transplantation.