It is extremely important to know the anterior abdominal wall anatomy prior to making an abdominal incision. Nerves, blood vessels, muscles and facial coverings are described in this presentation.

1. Abdominal
wall incisions
Dr. Indunil Piyadigama
Consultant Obstetrician and Gynaecologist
Medical Director
Base Hospital Kahawatta

2. Types of incisions
Transverse Midline Laparoscopic

3. Transverse incisions
Pfannenstiel
Joel-Cohen incision and Misgav Ladach technique of operating
Maylard transverse lower abdominal incision

4. Pfannenstiel
• 2 fingerbreadths (2-3cm) above the symphysis
pubis
• Slightly curved along the Langer’s lines

5. Joel-Cohen
incision
• 3 cm below the line joining anterior superior
iliac spines. (above Pf)
• Straight

6. Langer lines

7. Maylard transverse lower abdominal incision
Extends between the anterior superior iliac spines
Cutting the rectus muscle and inferior epigastric artery
Wertheim’s and pelvic node dissection can be done
Less chance of hernia and wound dehiscence than midline

8. Midline
incision
• From the skin fold below umbilicus to 1cm
above symphysis pubis
• Close with delayed absorbable (PDS) mass
closure

9. Advantages
and
disadvantages
of horizontal
incisions
Advantages Disadvantages
Easy to perform Limited access to the
upper abdomen
Quick to heal More blood loss
Less post of pain Nerve entrapment – 7%
Better cosmetic outcome
30 times stronger than
midline scar

13. Blood vessels

16. Thank you