Common Operations

General surgeries
Kocher's incision-
An oblique incision made in the right upper quadrant
of the abdomen, classically used for open
cholecystectomy.
Midline incision-
The most common incision for laparotomy , a
vertical incision which follows the linea alba
Battle’s incision-
Incision used in operation for appendicitis. Vertical
incision of the abdominal wall with temporary
retraction of the rectus muscle medially.
 Gridiron incision and Lenz incision-
Both incisions are made at McBurney’s point (two-thirds
from the umbilicus to the anterior superior iliac spine).
The Lanz incision is a transverse incision, whilst the Gridiron
incision is oblique (superolateral to inferomedial)
 Paramedian incision-

A surgical incision, esp. of the abdominal wall, close to the mi
dline.
 Transverse incision-
They involve passing through all of the abdominal muscles,
transversalis fascia, and then the peritoneum, before entering
the abdominal cavity.
Pfannenstiel incision-
A Pfannenstiel incision, Kerr incision, Pfannenstiel-
Kerr incision or pubic incision is a type of abdominal
surgical incision that allows access to the abdomen.
It is used for gynecologic and orthopedics surgeries,
and it is the most common method for performing
Caesarian sections today
 Cholecystectomy

This operation may be performed following the development of

stones in the gall-bladder and cystic duct (cholelithiasis).
The stones cause attacks of colic and jaundice and may obstruct
the bile duct. If there is an acute attack of cholecystitis the
surgeon may treat the condition conservatively until the
inflammation has subsided and then operate
 The surgeon may use a Kocher’s incision, a right

paramedian or midline incision.

 Provided that there are no postoperative complications the

patient usually makes a good recovery.

 Complications that may occur after this operation are:

pulmonary, Haemorrhage, or leakage of bile.

 Colostomy

 This is an artificial opening in the large bowel to divert the

faeces to the exterior where they are collected in a

disposable, adhesive plastic bag.
 Usually this procedure is carried out because of obstruction

or disease of the large intestine caused by diverticulitis,

Crohn’s disease or carcinoma.
 The colostomy may be temporary or permanent.
 A temporary colostomy is often placed in relation to the

transverse colon whereas a permanent one is usually placed

as far distally as possible.
 COMPLICATIONS

 There are a number of problems for a patient with a permanent

colostomy.
 Firstly, there is the worry about the success of the operation if it has

been carried out to remove a malignant tumor.

 Secondly, the patient will probably be concerned about his ability to

manage a colostomy, particularly if he is elderly.

 Thirdly, the patient will be concerned about whether he can lead a

normal life, and once out of hospital may tend to shun social
activities.
 Inguinal hernia

 This may be indirect or direct and is a protrusion of a sac of

peritoneum containing omentum and possibly intestine through the

inguinal canal.
 The indirect hernia is usually congenital and passes through the

length of the canal whereas the direct hernia is medial and projects
through a weakness in the posterior wall of the canal.
 The latter usually occurs in middle-aged to elderly men and often is

associated with stress on the abdominal wall caused by a chronic

cough or strain on lifting.

 In infants with a congenital abnormality a herniotomy with

removal of the sac may be adequate.

 In the adult more extensive surgery is preferable, unless the

risk of operation is too great because there are pulmonary

or circulatory problems.
 The operation performed is a herniorraphy which reduces

the herniation and repairs the weakness of the posterior

wall.
 Femoral hernia

 These are more common in women and are a protrusion of

the peritoneal sac through the femoral ring.

 The increase of intra-abdominal pressure that occurs in

pregnancy may be a precipitating cause.

 Surgery is usually the treatment of choice because of the

risk of strangulation.
Strangulated hernia
 This may require emergency surgery with resection of the

gangrenous section of the bowel.

 Umbilical hernias

 These are more common in children although they can

occur in older, obese patients with weak abdominal muscles

and possible weakness of tissues in the umbilical region.
 Incisional hernias

 These may occur through previous operation scars, usually

because of infection at the site of operation, or poor healing

which weakens the incisional area. Surgery may be
necessary if the hernia cannot be controlled with a pad and
abdominal belt as there may be a risk of strangulation.