Types of Abdominal Incision

1-Midline
This is one of the most common for abdominal surgery, allowing access to virtually all of the abdominal organs and the retroperitoneum, if necessary. After the skin and subcutaneous tisuses are incised, the linea alba is opened. The fascia transversalis, the extraperitoneal, connective tissue, and the peritoneum are then incised. It is easier to perform above the umbilicus because the linea alba is wider in that region. Advantages It is very quick to make as well as to close; .Good access to both sides of the abdomen * As the linea alba is relatively avascular It is almost bloodless ,no nerves are injured no damage to the muscle as muscle fibres are not divided Extension when required, can easily be made superiorly or inferiorly All these qualities make the midline approach especially suitable for emergency and exploratory surgery. :Disadvantages
Healing is poor and burst abdomen and incisional hernia liable to occur

:The paramedian incision --2

:Advantages Safe incision with no muscle cutting. {The rectus muscle is displaced * .{laterally .Have strong scar * .Disadvantages: Takes much time to do and to close
-4

3- Transverse incision:
This can be made above or below the umbilicus and can be small or so large that it extends from flank to flank. It can be made through the rectus sheath and the rectus abdominis muscles and through the oblique and transversus abdominis muscles laterally. It is rare to damage more than one segmental nerve so that postoperative abdominal weakness is minimal. The incision gives good exposure and is well tolerated by the patient. Closure of the wound is

made in layers. it is unnecessary to suture the cut ends of the rectus muscles, provided that the sheaths are carefully repaired.

4-OBLIQUE INCISIONS A-Subcostal(Kocher's) incision.

It follows the profile of the costal margin This can be right subcostal, used mainly for open cholecystectomy, or left subcostal, used mainly for splenectomy. A combination of both is called a roof-top incision, useful in gastric and hepatopancreatobiliary surgery. When extended up the midline (as may be required to implant a liver, for example)

B- Muscle splitting, or MeBurneys incision: This is chiefly used for appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead. An oblique skin incision is made in the right iliac region about 2 inches (5 cm) above and medial to the anterior superior iliac spine. The external and internal oblique and transversus muscles are incised or split in the line of their fibers and retracted to expose the fascia transversalis and the peritoneum. The latter are now incised and the abdominal cavity is opened. The incision is closed in layers, with no postoperative weakness.
.