pdf_booklets_abdominal incisions

8/7/2019 pdf_booklets_abdominal incisions

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Abdominal incisions

A simple guide for nurses

Prepared by:

Mr. Varghese. Y

M.Sc., (N), II year

Shanmuga College of Nursing

Salem


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Abdomen walls:-

(i) Skin(ii) Subcutaneous fat Anterior(iii) Rectus sheath Rectus Abdominis(iv) External peritoneal fat Posterior(v) Peritoneum

Abdominal Incisions:-

Incisions for various laparotomy procedure

Types:-

I) Vertical Incisions:-

II) Horizontal Incisions:-

III) Transverse Incisions:-

Para Side

Median Midline


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(i) Vertical Incision

(ii) Horizontal Incision


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(i) Transverse Incision


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Vertical Incisions:

(1)Supra Umblic Midline Incision (SUMI):-Definition:-

Making incision above the Umblicus in midline of adomen.

Layers to Open:-

Skin Subcutaneous fat Anterior Rectus abdominis Rectus sheath Posterior Rectus Umblicus External Peritoneum Peritoneum


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Procedure:-

Emergency Vagotomy / Gasterior : Jejunostomy Gatrectomy total (or) partial Pancreaolomy Dueodenectomy]

Advantages:-

Easy to open because minimum midline layers. Less bleeding because of Avascular layers Fast to open

Disadvantages:

Weak layer because of incision hernia is common. Extensive is difficult, is not possible for removal of stemum.

(2) Infra Umblical Midline Incision (IUMI):-

Definition:-

Making incision below the umbilicus the middle of abdomen.


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Layers to open:-

Skin Subcutaneous fat Anterior Rectus abdominis Rectus sheath Posterior Rectus Umblicus External Peritoneum Peritoneum

Procedure:-

(i) Total Abdominal Hystrectomy(ii) LSCS (Lower Segment Cesarian Section)(iii) Sulphingo Oophrectomy(iv) Cystostomy(v) Cystecotomy

Advantages:-

Easy to open because of avascular line Less bleeding

Fast to open

Disadvantages:

Weak layer because of incision hernia is common. Extension is difficult because of umbilicus.

(3) Right Para Median Incision (RPMI):-

Definition:-

Making incision on the Rt. Side of midline of abdomen.

Layer to Open:-

Skin Subcutaneous fat (Anterior Rectus between rectus sheath) External oblique apponeurosis


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External oblique muscle Internal oblique apponeurosis Transverse abdominis External Peritoneum Peritoneoum

Procedure:-

Cholecystectomy. Choledochastomy (open a ---------------) Perforature closure (Perforature) i.e., Duodenal ulcer

perforature closes

Pyloroplasty


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Rectus sheath Posterior Rectus Exterior rectus External Peritoneum Peritoneoum

Procedure:-

Spleenectomy Distal Pancreadectomy (removal body and tail of pancreas) Gastreotomy Fundaapplication

Advantages:-

Strong layers to no chances for incisional hernia Extansibilty easy

Disadvantages:-

Bleeding will be more Post operative pain is severe, because of transverse nerve


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Horizontal Incision

(1) Right Subcostal Incision (RSI) or Kochers Incision:-

Definition:-

Making incision just bleow the lower rib on right side of abdomen

is called Rt. Subcoastal incision (or) Kochers Incision.

Layers to Open:-

Skin Subcutaneous fat External Oblique apponeurosis External Oblique muscle Internal oblique muscle Transverse addominis External Peritoneum Peritoneoum


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Procedures:

Cholecystostomy Partial Heptectomy Liver Surgery Bilary Externic anastomosis Tumor excessive

Advantages:-

Easy accessibility Easily extensibility Restriction of Diaphragm movement because to basal

peritonitis.


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(2) Left Subcoastal Incision (LSI):-

Definition:-

Making incision just below the last rib on the left side of abdomen.

Layers to open:

Skin Subcutaneous fat External Oblique muscle Internal oblique muscle Transverse addominis External Peritoneum Peritoneoum


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Procedures:-

Spleenectomy Bilrth Surgery (Pastial Gastrectomy) Helle Myotomy

ie. It is a condtion dilation of oesophagus called Achalasia Cardia

Advantages:-

Easy accessibility Easy entenstabilty

Disadvantages:-

Bleeding will be more. Post-operative pain will be more Restriction of Diaphragm movement. E.g: Basal Peritonitus

(3) "Roof Top Incision:-

Definition:-

Making incision just below the rib on both side of abdomen.

Layers to open:-

Skin Subcutaneous fat Linea alba External Peritoneum Peritoneoum

In Laterally:-

Skin Subcutaneous fat External Oblique muscle Internal oblique muscle Transverse addominis


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External Peritoneum Peritoneoum

Procedure:-

Liver Transplant Pancreatic Transplant Whipples Procedure (Radial Pancrea toduodenectomy for

Carcinoma of hed of pancreas)

Abdominal Aortic Surgery

Mercedes Benz Incision:-

Defintion:-

A combination of vertical and transverse making incision just

below the lower rib on both side of abdomen with extension vertically in

midline.


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After layers and procedures are some as Roof Top Incision.

Procedures:-

Liver transplant Pancreatic Transplant Whipples Procedures Abdominal Aortic Surgery

Advantages:-

Easy accessibility Good Visualization Wide working space

Disadvantages:-

Bleeding will be more


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Severe post operative pain Restricted Diaphragm Long time consisting more.

(4) Right Inguinal Incision (or) Rt. Iliac Incision:-

Definition:-

Making incision just below the inguinal cannal (or) iliac hole on the

Rt. Side of abdomen.

Layers to Open:-

Skin Subcotaneous Fat External Oblique Muscle


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Internal Oblique Muscle External Opponeurosis Inguinal cannel.

Procedures:-

Rt. Inguinal Hernia Surgerya) Hermotomy (Child)b) Hermorraphy (Adult)c) Hernioplasts (Old Age)

Rt. Femoral Hernia Surgery Rt. Spermatic Cord Surgery

a) Vas differentb) Vesticular Arteryc) Vesticular Vein

Rt. Vericocelotomy

Advantages:-

Easy accessibility No need to open peritoneal cavity

Disadvantages:-

Nerve injury is very common. i.e. Common nerve get injuryilio hypagastric nerve, iliac ingunnal nerve

Injury to spermatic cord for testis

(5) Left Inguinal (or) Iliac Incision:-

Definition:-

Making incision just below the iliac cannal (or) inguinal cannal on

the Lt. side of abdomen. Layers to open same as Rt. Iliac incision.

Procedure:-

Lt. Inguinal Surgery Lt. Femoral Hernia Surgery


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Lt. Spermatic Cord Surgery Lt. Vericocelectomy.

(6) Pfannenstiel Incision:-

Definition:-

Making incision just above iliac bone (or) Inguinal cannal on both

side of abdomen.

Layers to Open:-

External Oblique Muscle Internal Oblique Muscle Transverse Abdmominis External Peritoneum Peritoneum

Mid Line:-

Anti-Rectus Abdominas


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Rectus Sheath Post-Rectus Abdominis External peritoneum Peritoneum

Procedure:-

Lower Segment cesarian Segment (LSCS) Cystecotomy Total Abdominal hysterectomy Bilateral salphingo oophrectomy Cystostomy

Advantages:-

Cosmatic Incision Pain will be more.


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Oblique Incision

(1) Right Oblique Incision:-

Definition:-

Making incision on abdomen obliquely from anterior abdominal

wall to lateral abdominal wall at right side.

Layers to open:-

Skin Subcotaneous tissue External Oblique apponeurosis External Oblique Muscle Internal Oblique Muscle Peritoneum


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Procedure:-

Nephrectomy Urethrolithotomy (Removal of a calcius from Uterus i.e

open and remove stone

Advantages:-

More specific incision No need to open pesitoneum

Disadvantages:-

Sever bleeding] Injury to pleura is common because it is near or caused

pneumothorax.

Less accessibility

(2) Left Oblique Incision:-

Definition:-

Making incision on abdomen obliquely from anterior abdominal

wall to lateral wall to lateral abdominal wall at left side.

Layers to Open:-

Skin Subcotaneous tissue External Oblique apponeurosis External Oblique Muscle Internal Oblique Muscle Peritoneum

Advantages:-

More specific incision No need to open pesitoneum


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Disadvantages:-

Sever bleeding] Injury to pleura is common because it is near or caused

pneumothorax.

Less accessibility(3) Mc. Burneys Incision:-

Definition:-

Making incision on Mc. Burneys Point (Mc. Burneys poiont is

cutting the layer. Lateral and medally 2/3 i.e from umbilical and far

lateral is anterior supra iliac spine. The spino umbilical line).

Layers to open:

Skin Subcotaneous tissue External Oblique apponeurosis External Oblique Muscle


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Internal Oblique Muscle Transverse abdominis Peritoneum-again cut

Procedures:-

Appendectomy Drainage of appendicular abscers Caecostomy (open of caecum) Ilio Cacal Lymh biopsy

Advantages:-

More specific incision Less bleeding because of cutting muscle

Disadvantages:-

Less accessibility Ilio inguinal nerve will get injury then causes


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