What Are the Types of Abdominal Incisions?

Reviewed on 1/28/2021

Abdominal Incisions
An abdominal incision is a cut made through your skin on the belly to expose the abdominal organs or to facilitate an operation or a procedure.

Incisions or cuts on your belly are mostly made during an emergency or a planned surgery. Although laparoscopic surgery has reduced the need for large incisions, certain conditions still require abdominal cuts or incisions.

Although cuts heal in due time, they can weaken the abdominal muscle and interfere temporarily with normal abdominal (belly) wall functions. There are various types of abdominal incisions:

  • Vertical incisions: 
    • Midline incisions or median incisions: These incisions are made on the midline of your abdomen (belly). It is mostly favored in open surgery for diagnostic purposes (laparotomy) because it allows wide access to all areas of your abdomen and organs. It allows almost bloodless surgery with a minimum risk of injury to the blood vessels and nerves.
    • Paramedian incisions: These incisions are made 2-5 cm beside the midline of the trunk on your abdomen (belly). It provides access to tummy structures such as the stomach, liver, and spleen. It avoids any injury to the nerves, limits trauma to your rectus (belly muscle), and permits good restoration of functions afterward.
  • Transverse incisions: These incisions cosmetically appear better. They are stronger and less painful. They allow good access to the upper digestive organs. It can be used in surgeries performed on children because their tummy girth is longer transversely than vertically. Moreover, it is used in surgeries performed on people who are overweight and have short stature. Transverse incisions reduce the risk of dehiscence (wound bursting open). However, the risk of protrusion of the organs through the abdominal wall is higher with these incisions.
    • Pfannenstiel's incisions: These are the most common muscle-separating incisions. They are frequently used for women’s reproductive- and urinary system-related operations. They are commonly used for cesarean delivery because they provide a cosmetically better appearance. They are also known as bikini incisions. They are made just 5 cm above your groin area (pubic) and are mostly 12 cm long.
    • Cherney's incisions: These are made 2-3 cm above the groin area, lower than Pfannenstiel's incisions. They provide excellent access to the pelvic organs during urinary bladder or vaginal repair surgeries. Because they are a tendon-detaching operation, reattachment of the tendons (fibrous collagen tissue band) is tedious.
    • Maynard's incisions: These are true muscle-cutting incisions. They give excellent exposure to the genital organs. They are made parallel to the traditional placement of Pfannenstiel's incisions. They are also as popular as Pfannenstiel’s incisions for cesarean delivery and are used for cancer surgeries.
    • Modified Gibson incisions: These incisions are specifically made during surgeries related to women’s reproductive system or cancer surgeries. Cuts are made on the side of the midline of the abdomen (belly), most often made only on the left side.
  • Oblique incisions: Several oblique incisions are used for specific organ exposures.
    • McBurney's incisions: These are specifically used for appendectomy (appendix removal operation). They are made at the junction of the middle third and outer third of the line running from the navel to the upper margin of the pelvic girdle.
    • Subcostal incisions: These start at the midline. They are 2-5-cm incisions below the lower part of the sternum (breastbone) that extends down outward parallel to the lower edge of the chest-rib. They provide easy access to the gallbladder and spleen. They are often performed in gallstone removal operations.

What do abdominal incisions mean?

An abdominal incision is a cut made through your skin on the belly to expose the abdominal organs or to facilitate an operation or a procedure.

What are the factors considered while selecting an incision?

The surgeon will choose the incision best suited for the planned procedure based on the following most essential factors:

  • Accessibility to the affected organ or anticipated pathology
  • Extensibility of incision
  • Preservation of abdominal wall function
  • A reliable and secure closure of the incision

Moreover, other factors influence the selection of incisions such as:

  • Type of surgery (elective or emergency)
  • Need for rapid entry into the belly
  • The certainty of the diagnosis of your disease
  • Target organ
  • Location of previous surgery scars
  • Body habitus such as weight and height of the patient
  • Possibility of significant bleeding
  • Cosmetic outcome
  • Surgeons own experience and preference

What are the complications of abdominal incisions?

The complications of abdominal incisions are as follows:

The complications of incisions nowadays have been reduced because many surgeons are now opting for mini-incisions as small as a keyhole (laparoscopic surgery).

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References
Higgins RV. Abdominal incisions and sutures in gynecologic oncological surgery. Medscape: https://emedicine.medscape.com/article/271349-overview

Meeks RG, Trenhaile T. Incision decisions: Which ones for which procedures? OBG Manag. March 2002;14(3):16-33. https://www.mdedge.com/obgyn/article/61112/incision-decisions-which-ones-which-procedures

Anonymous. Abdominal incisions in general surgery: A review. Ann Ib Postgrad Med. 2007;5(2):59-63. https://europepmc.org/article/pmc/pmc4110992

Mizell JS. Incisions for open abdominal surgery. UpToDate. https://www.uptodate.com/contents/incisions-for-open-abdominal-surgery#H3294974

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