The incision was closed in layers, and a drainage tube was used. It is commonly used for open appendicectomies. The most commonly documented postoperative complication is incisional hernia, which occurs in approximately 9-20% of patients after an abdominal closure. Probably because of this he had less problems with postoperative tetany. Paramedian closure is similar in technique to midline closure; however, it is necessary to ensure reapproximation of the anterior and posterior rectus sheath when above the arcuate line (see the image below). O'Meara L, Ahmad SB, Glaser J, Diaz JJ, Bruns BR. The Kocher incision is a subcostal incision on the right side of the abdomen used for open exposure of the gallbladder and biliary tree. Am Surg. [Full Text]. - Character 02:14 The rectus muscles are separated and the incision is made in the midline. The incision must be tailored to the patients need but is strongly influenced by the surgeon's preference. Kocher A Kocher incision begins inferior to the xiphoid process and extends inferolaterally in parallel to the right costal margin. Abdominal Incisions - Lanz - Kocher - Midline - TeachMeSurgery Kirk RM, Ribbans WJ, eds. The incision is made to run parallel to the costal margin, starting below the xiphoid and extending laterally. 1990 Jan. 77 (1):107. 2009 Apr. A modification was introduced by Nyhus which used a transverse (oblique) skin incision 3cm above the inguinal ligament and a transverse incision (oblique) to divide the anterior rectus sheath. The complications of abdominal incisions are as follows: Hematoma (bleeding underneath the skin) Stitch abscess. Negative side-effects of retention sutures for abdominal wound closure. Risk factors that could influence the choice of abdominal cavity approach are risk of incisional hernia, pain, bleeding, and infection. [29], In the past, abdominal midline surgical wound dehiscence rates as high as 10% were reported To find out more, read our privacy policy. The average length of the incision is approximately 24 to 30 inches. Transverse incisions are felt to have more intrinsic strength than their vertical counterparts because the abdominal fascia fibers are transversely oriented, causing sutures to be placed perpendicular to the fiber direction (see the image below). Tenderness at McBurney's point; Muscle guard and rebound tenderness over the appendix; Appendicectomy is usually performed through a muscle-splitting incision in the right iliac fossa. This incision is just inferior and parallel to the subcostal margin. The first is a continuous locking suture taking most of the myometrium but not passing through the decidua to guard against endometriosis and weakness of the scar. Interrupted closure was associated with significantly less dehiscence than continuous closure , and no differences were found between the two methods with regard to hermia risk. Please confirm that you would like to log out of Medscape. The posterior sheath is formed by the posterior leaf of the internal and the transversus abdominis aponeuroses and bears the superior and inferior epigastric arteries and their anastomotic network. Theyinvolve passing through all of the abdominal muscles, transversalis fascia, and then the peritoneum, before entering the abdominal cavity.

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