PDF Abdominal incisions and sutures in obstetrics and gynaecology Higher risk of scar dehiscence and uterine rupture in subsequent pregnancies (1 in 50) [1]. The Pfannenstiel incision is a transverse skin incision, two finger-breadths above the symphysis pubis, which is extended in the direction of the anterior superior iliac spine (ASIS) and ends 2-3 cm medial to ASIS on both sides. The presumed disadvantages of a midline incision, compared with a transverse incision, include an increased risk of wound dehiscence and hernia formation. Abdominal Surgery Flashcards | Quizlet The Cherney and Maylard are two alternative transverse incisions. incision, originally described to prevent incisional (D) History of hemostatic defects (E) Activated clotting time longer than 180 seconds hernias, has been subsequently considered the incision (F) Allergy to any of the medications . disadv: requires more time interrupts vessels and nerves passing from lateral to median thus resulting in atrophy of muscle medial to the incision This type of incision takes time to perform. Therefore, an operator should consider the factors that influence both the incisionprocessandtheoutcome,suchasincision extensibility, speed of operation, presence or absence of adhisions or infections, hemostasis problems, possibility of post-operative hernia or dehiscence . MacFadden M, Peacock EE (1983) Preperitoneal abdominal wound repair: Incidence of dehiscence. The objective of the study was to compare surgical wound outcome and satisfaction of women who underwent Pfannenstiel incision closure with interrupted vs. subcuticular suturing in caesarean sections. While the vertical midline incision remains most popular and is, perhaps, the most versatile, a variety of other incisions may have distinct advantages in specific settings. Methods: This is a retrospective comparative study from February 2004 to February 2017 and the number of patients studied was 116. The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. However some Excellent cosmetic results, principles of less traumatic surgery, and a rare incisional hernia complication rate of about 0-2%, as well as long-time use characterise this access path to the pelvic organs first described by the German gynaecologist in 1900. rapid entry into abdomen and pelvis with median incision Disadvantages: 5wound dehiscence and hernia may be more frequent poorer cosmetic results higher infection rates, haemorrhage and operative time with paramedian incision7 Figure 1. Gynecologists are most familiar with the Pfannenstiel and midline incisions for laparotomy. Aylin Mert 0902110019 Surgical Incision is a cut made through the skin to facilitate an operation or precedure. Each incision has its own advantages and disadvantages; it is up to the surgeon to choose the route of entry that provides the best exposure for the intended operation while limiting morbidity to the patient. Here, a guideline to the advantages and disadvantages of commonly used longitudinal and transverse incisions and the procedures for which they are best suited. If a Pfannenstiel incision has been made and additional lateral pelvic exposure is needed, convert the incision to a Cherney. Draw the line for Pfannenstiel incision on abdominal wall. Fig. For which surgery this approach may be used? In addition, smaller incisions are associated with a lower portant disadvantages when compared to the open ap-proach: the learning curve and the operative costs. The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. It is used for gynecologic and orthopedics surgeries, and it is the most common method for performing Caesarian sections today. Further advantages include the ease with which the incision may be extended either cephalad or caudally in order to improve access. 23.1). Laparoscopic myomectomy, using either a standard or robotically assisted technique is the preferred method when feasible.The primary advantages of laparoscopy compared to laparotomy are less postoperative pain and shorter recovery time [15, 16].The disadvantages are that it requires specialized skill and equipment, closure of subsequent myometrial defect can be difficult using standard . Each method has its own advantages and disadvantages. The main advantage of the midline incision is that its lower limit extends to the pubic bone. There are advantages and disadvantages from a surgical perspective with each incision type. The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. It is used for gynecologic and orthopedics surgeries, and it is the most common method for performing Caesarian sections today. The assumed advantages include reducing postoperative pain and achieving better remobilization because detaching the muscle was not necessary. Stj.Dr. Pfannenstiel incision The Pfannenstiel incision results in good exposure to the central pelvis but limits exposure to the lateral pelvis and upper . Only one smaller case-matched study documented superiority for the laparoscopically assisted group in terms of faster return of intestinal function and . . Alleged disadvantages of transverse incisions Surgeons who favor low midline vertical incisions for gynecologic surgery do so mainly as a matter of habit based on their training experience. Each closure technique bring to the table its unique set of advantages and disadvantages. 24 . advantages, as well as disadvantages for diathermy use in making a skin incision [1-4]. Greater blood loss. What are the advantages and disadvantages of cesarean delivery for mothers and neonates? Most studies that support this idea are retrospective or lack proper statistical design. Disadvantages were the mechanical challenge in laparoscopic manipulation of very large . Patients were divided into group A (Pfannenstiel incision) and group B (midline incision). Aim: The present study is to assess the morbidity on comparing Pfannenstiel vs. midline incision following minimally invasive radical cystectomy. Two standard incisions are used for retropubic radical prostatectomy, a midline vertical and a transverse Pfannenstiel incision.Both of these incisions have their advantages and disadvantages. What complication shown with tracheostomy tube inserted? Both provide superior pelvic exposure compared with the Pfannenstiel incision and offer significant benefits over a midline . Both the Cherney and Maylard incisions pro-vide additional exposure to the pelvis, espe-cially laterally, which is advantageous when complex pathology is limited to the pelvis. 2) may be enlarged . approximate the skin in caesarean section. This incision allows quick entry into the abdominal cavity with little blood loss, and it is easily extended in length to accommodate the operative findings. Lanz incision, 4. A Pfannenstiel incision offers more exposure than a Kustner incision. Joel-Cohen versus Pfannenstiel incisions. Advantages Smaller incisions, Pfannenstiel incision can be avoided Rectus abdominis and pyramidalis muscles are not compromised Safe preparation with good visualization of the corona mortis vessels Fast remobilization and fast recovery Better visualization of the medial fracture zone that usually can only be palpated: Disadvantages minimum nerve damage, rapid entry to abdomen 7 what are the disadvantages of vertical incision? There are three routes of entry, low transverse (or Pfannenstiel), classical, or low vertical incision which can be made. What other Some surgeons favor a pure laparoscopic approach, while others prefer a hand‐assisted approach for major laparoscopic liver resections. what is the description of the pfannenstiel incision? Choice of Incision Abdominal incisions can be vertically, transversely, or obliquely oriented. The PFAP is adaptable to other baccalaureate nursing programs. These vessels should be ligated when encountered. These are both muscle splitting incisions that retain the advantages of a low transverse skin incision while providing greater exposure to the pelvis. Gable incision, 2. transverse muscle splitting, 3. Basic characteristics of transverse incisions Advantages: These incisions give the best cosmetic results, they give a much stronger scar than midline incisions and less painful than longitudinal inci- The Pfannenstiel incision is a most commonly used incision in women having a first CS and is also used in case a repeat a CS is required. Laparoscopic liver resections are being performed with increasing frequency, with several groups having reported minimally invasive approaches for major anatomic hepatic resections. Abstract. Although gynaecologists may be most familiar with the Pfannenstiel and midline laparotomy incisions, the Cherney and Maylard incisions are two alternative transverse abdominal incisions with unique advantages. In doing so, three essentials should be achieved: 1.Accessibility 2.Extensibility 3.Security In summary, published retrospective and non-randomized prospective studies have not clarified the advantages and disadvantages of periumbilical versus Pfannenstiel incisions in HALDN. Ann Surg 225: 365-369 CrossRef Google Scholar. The HAPERPACT trial will be the first RCT to compare the outcome of HALDN using two different types of incision. A low transverse or Pfannenstiel incision above the pubic symphysis is commonly done for cesarean sections. that a transverse abdominal incision, for example, the Maylard or Pfannenstiel incision, is more anatomically correct than a vertical incision. It should be the aim of the surgeon to employ the type of incision considered to be the most suitable for that particular operation to be performed. The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. 19.2).This was a particular concern in cases of suspected or known malignancies where specimen morcellation by some, was "neither appealing nor desirable" []. access to the uterine fundus may be required (classical caesarean section). The presumed disadvantages of a midline incision, . Advantages Provides access to lateral structures Avoids injury to nerves,limits trauma to rectus muscle. Indications Delivery by CS can be performed either as an elective… A Pfannenstiel incision /ˈf?ːn?n?tiːl/, Kerr incision, Pfannenstiel-Kerr incision or pubic incision is a type of abdominal surgical incision that allows access to the abdomen. The subcutaneous layer is opened via sharp dissection . Purported disadvantages of electrosurgical skin incisions are fears of deep burns; with resultant scaring, slower wound healing [2], The HAPERPACT trial will be the first RCT to compare the outcome of HALDN using two different types of incision. Abstract. 1. Excellent cosmetic results, principles of less traumatic surgery, and a rare incisional hernia complication rate of about 0-2%, as well as long-time use characterise this access path to the pelvic organs first described by the German gynaecologist in 1900 . Lanz incision and Gridiron incisions: used to access the appendix, mostly to perform . Objective: To study the feasibility ,advantages and disadvantages of combined cholecystectomy at the time of cesarean section, and to compare laparoscopic versus mini-laparotomy approache. The Myth and Reality Incision choice. Advantages. and ureter division, a modified Pfannenstiel incision was done (Figure-1) and the assistant's hand was in- Pfannenstiel Incision: •The skin and SC tissues are incised using a transverse curvilinear incision 2 fingerbreadths above the symphysis pubis extending from and to points lateral to the lateral margins of the abdominal rectus muscles. This incision is made transversely in a manner similar to the Maylard incision, although some surgeons may prefer to curve the incision upward toward the anterior superior iliac spine to gain more exposure (the "smile" incision) ( Fig. The incision can be up to 2 feet. Pfannenstiel-Kerr incision or pubic incision is a type of abdominal surgical incision that allows access to the abdomen. specimen is then removed through a Pfannenstiel or other off-midline extraction site incision. A vast majority of the procedures are carried out with Pfannenstiel incision. The various advantages and disadvantages of abdominal incisions are summarized in Table 2. Introduction: Caesarean section is the most common surgical procedure performed in the world. Excellent cosmetic results, principles of less traumatic . Intracorporeal anastomosis advantages Since the colon does not require exteriorization for resection and anastomosis, there is no need to mobilize bowel that will remain in-situ, and no traction is required The majority of studies exclusively using laparoscopically assisted techniques with a Pfannenstiel incision have not been able to show advantages for the laparoscopic procedure [10-12]. Disadvantages include patients experiencing more pain than they would from a transverse incision, particularly during deep breathing postoperatively, and the incision is perpendicular to the Langer's skin tension . Advantages: Adequate exposure of most if not all of the abdominal viscera, Minimal blood loss as the incision is through the linea alba, Minimal nerve injury, Minimal muscle injury, Can be quickly made, such as in an emergency and quickly closed with a mass closure technique Disadvantages: Care needs to be taken just above the umbilicus where . Intracorporeal anastomosis advantages Since the colon does not require exteriorization for resection and anastomosis, there is no need to mobilize bowel that will remain in-situ, and no traction is required to deliver the specimen to a small . Maylard incision, 5. Permits good restoration of abdominal wall function Can be extended by slanting the upper end of the incision medially towards the xiphoid process if required Disadvantages Time consuming. Aim: The present study is to assess the morbidity on comparing Pfannenstiel vs. midline incision following minimally invasive radical cystectomy. The objective of this study is to compare efficacy of cyanoacrylate glue versus vertical mattress sutures for percutaneous closure of pfannenstiel incision after lower segment cesarean section (LSCS) in terms of scarring, post-operative pain and analgesic . A thoracoabdominal incision is a single, large incision that spans both body cavities. 4 A "lateral paramedian incision" refers to a vertical incision created several centimeters lateral to the location of the traditional paramedian . students in PFAP are accustomed to the advantages and disadvantages. Its advantages and disadvantages are compared to the fornix and limbal are discussed. additional advantages of an extraperitoneal approach was the compartmentalization of any urinoma or . Surgical Incisions. Kustner Incision: It is transverse in nature and extends from the symphysis pubis till the iliac spine (anterior). This incision is dedicated to the radical retropubic prostatectomy procedure in its fullest sense. Advantages and disadvantages of this incision. This is a transverse incision made parallel to and approximately 2 fingerwidths cephalad to the pubic bone. Higher incidence of adhesions. A vertical skin incision is indicated in cases of : extreme maternal obesity, suspicion of other intra-abdominal pathology necessitating surgical intervention . Increasingly the low transverse is used in the UK, leaving a scar which is usually low enough to be easily hidden visually. Box 1. Historically, the obstetriciangynecologist has preferred this type of incision. The most commonly performed is the Pfannenstiel or horizontal suprapubic incision. The combined advantages of a transverse and vertical incision are thereby achieved. 25 Related Question Answers Found . assisted technique with a Pfannenstiel incision to a stand-ard conventional approach [14]. Pfannenstiel incision, 6. Divide, number and sign in Latin the division of the anterior abdominal wall into nine sections. The Joel-Cohen incision (Fig. . The Cherney incision involves dividing the The skin is incised transversely, often with a convexity downward to avoid dissection of blood vessels and nerves. perform the surgery without the Pfannenstiel incision and keep the rectus abdominal muscle completely intact. Advantages: 1) provides greater ease of access to the pelvic and intra-abdominal organs . More cosmetic Scar is almost imperceptible; Hidden in the pubic hairline The Pfannenstiel-Kerr technique consists of the Pfannenstiel incision (Figures 1-3), which is a transverse skin incision, two fingers above the symphysis pubis, which is extended in the direction of the anterior superior iliac spine (ASIS), and ends 2-3 cm medial to ASIS on both sides . Abstract. Patients were divided into group A (Pfannenstiel incision) and group B (midline incision). Pfannenstiel Incision. 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