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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