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.
