Types of abdominal and pelvic surgical incision

At the time of a surgical procedure, while making an incision a doctor has to take care of a number of factors before making an incision. Considering a number of factors, different types of incisions have come into fore, such as 

Midline Incision: It s the commonest incision and is done along the linea alba (fibrous structure running through the mid of the abdomen). These are preferred, especially in diagnostic laparotomy as it permits a wide access to the abdomen.
Pfannenstiel Incision: It is transverse in nature, extending from the umbilicus to the pubic-symphysis. It is generally employed for abdominal hysterectomy of benign nature and caesarean section.
Chevron Incision: It is an incision under the rib-cage and is done on the abdomen. It starts from beneath the ribs on the right abdomen and extends till the other mid axillary line. Thus, the entire abdominal width is incised for proper reach into the liver. The incision can be up to 2 feet.
Kustner Incision: It is transverse in nature and extends from the symphysis pubis till the iliac spine (anterior). This type of incision takes time to perform. A Pfannenstiel incision offers more exposure than a Kustner incision.
Lanz Incision: It is a variation of the more common mcburney-incision (also known as Gridiron s incision). It is generally used for open appendectomies. There are quite a few variations for this type of an incision.
Gridiron s incision: It is done for appendectomies. It is an oblique short incision which is done in the lower right quadrant in the abdomen.
Kocher s Incision: It is oblique in nature, extending from the abdominal upper right quadrant and is generally used for performing an open cholecystectomy. Gallbladder, biliary tract and certain liver operations can be suited for a Kocher s incision. This however is different from the same named incision used for the thyroid gland surgery.
Cherney Incision: It is transverse in nature. It allows a great range of exposure for the pelvic sidewall. It is less painful than a midline incision. It allows for the greatest pelvic exposure and hence is a widely preferred and practiced incision.

8 Types Abdominal and Pelvic Surgical Incisions

The abdomen houses multiple organs and pain in the abdomen could indicate a problem with any of these organs. From a medical point of view, the abdomen and associated pain can be divided into nine areas or quadrants the right, middle and left sideways and the upper, middle, and lower quadrants from top to bottom. The doctor would usually ask the patient to point to the area of the problem for instance, right lower quadrant or upper left quadrant.

With a mental mapping of the organ in each of these quadrants, the diagnosis is arrived at, with confirmation by imaging if required. Some of the most common causes for lower abdominal pain are listed below, and the kidneys are important organs in this area.

Lower left abdominal pain is caused because of the problems in the large intestine, small intestine, spleen, left kidney, ureter, ovaries, fallopian tube, urinary bladder and their associated structures.
Some of the common issues in this area could be menstrual cramps, urinary tract infections (UTIs), left kidney stones, uterine disorders, intestinal obstruction, ectopic pregnancy, constipation, colon cancers, pelvic inflammatory disorder, Crohn s disease, inguinal hernia, and a ruptured spleen.
Lower right abdominal pain can be due to appendicitis, right inguinal hernia, UTI, right kidney stones, colon cancer, menstrual cramps, uterine disorders, intestinal obstruction, ectopic pregnancy, pelvic inflammatory disorders, diverticulitis, Crohn s disease, endometriosis, and lymph node inflammation.
As is evident from this list, many of these are related to the urinary tract and kidneys. Whether it is the kidneys per se, the urinary bladder, the ureters, or the associated nerves and blood vessels, UTIs are very common. And if one of these organs is affected, then the chance of the infection spreading to the surrounding organs is very high. There is a constant flow of urine through these structures, and so the infection can pass through easily.
A person who has had kidney problems would have very characteristic symptoms. The pain would be in the lower back, on either side of the spine, depending on which side is affected. While the pain experienced due to kidney stones is acute and can be stabbing in nature, the UTI would appear in bouts. The associated symptoms should always be kept in mind when identifying and treating kidney problems.
There could be nausea, diarrhoea, blood in the urine, fever, profuse sweating and severe fever, which could help in discovering the problem.
These should not be ignored and diagnosis should be confirmed with blood tests and imaging including X-rays and CT scans. The treatment would depend on the condition, and early identification of the problem leads to better prognosis and a simpler treatment.

Lower Abdomen Pain - Can It Be A Sign Of Kidney Problem?

Gallbladder removal, termed as cholecystectomy, is regarded as one of the most commonly opted surgical procedures. Laparoscopic surgery for cholecystectomy is the process of removing the gallbladder with laparoscopic techniques. It is a minimally invasive surgery where the surgical procedures are performed with the assistance of different minute instruments and a video camera.

Advantages of Laparoscopic surgery for cholecystectomy
The most commendable reason why people favour laparoscopic surgery is that in place of having to undergo a five to seven-inch incision, this surgical process requires only four small incisions in the abdomen. Moreover, there is minimal post-operative pain and the patients are able to recover faster than patients who have undergone open gallbladder surgery. Most patients can go home the same day as the surgery and can have a quick return to day to day activity.

Determining whether you are a good candidate for laparoscopic surgery
Even though there are numerous benefits of laparoscopic gallbladder surgery, the process may not be suitable for all candidates as it is generally not suggested for patients who suffer from severe and complicated gallbladder disease or have a history of undergoing upper abdominal surgery. A comprehensive medical evaluation by the physician and subsequent consultation with the surgeon is essential in determining whether a patient is a suitable candidate for laparoscopic removal of the gallbladder.

Undergoing the laparoscopic surgery for gallbladder removal
Once you are recommended to undergo laparoscopic gallbladder removal, your doctor will advise you certain preoperative measures that you must follow before the surgery. It is suggested to take a shower the night before the operation and not to eat anything from the night before the operation. Also, drugs such as anticoagulants, arthritis medicines, and Vitamin E medications must also be stopped temporarily for several weeks before the surgery.

The surgery is performed under general anaesthesia. Therefore, the patient is asleep all through the process. The surgeon first inserts the cannula into the abdomen and then a laparoscope is connected to a specific camera through the cannula. Subsequently, other cannulas are also inserted which help the surgeon to separate the gallbladder from the attachments and then remove it completely through one of the apertures. Once the surgeon removes the gallbladder successfully, the small incisions are closed with dissolvable surgical tape or glue.

It is an overall safe procedure, and the rate of complications is much lower which makes it the most effective and popular treatment option.

Laparoscopic Surgery For Cholecystectomy - Who Should Go For It?

Abdominal pain can be triggered by a number of factors. Sometimes, it's mild enough to be overlooked while at others, the pain can be debilitating. Most abdominal problems start with the same symptoms and hence the cause of this pain can be a little difficult to pin point. In many cases, the location of the pain can help understand the factors that are triggering it.

Generalized pain can be simply be triggered by indigestion. On the other hand, it could also be a symptom of a number of illnesses like irritable bowel syndrome, appendicitis, viral gastroenteritis and intestinal obstructions etc. However, the former are more common. This type of pain resolves itself without medical intervention.

In other cases, abdominal pain can be localized to the upper or lower abdomen on the right or left side or in the centre of the abdomen. This sort of pain is usually sporadic and comes and goes with great intensity. In most cases, this sort of pain is a symptom of a serious problem and should not be ignored. One of the most common examples of localized abdominal pain is the pain caused by appendicitis in its later stages. Severe pain that is located just above the centre of the belly button could be a sign of pancreatitis. A burning sensation and severe cramps in the center of the stomach could point towards stomach ulcers that could cause perforations if left untreated. Other causes for this type of pain include endometriosis, ovarian cysts, angina, kidney infections and a spleen infection.

Mild stomach pain whether localized or general can be relieved using home remedies and does not often require medication. However, if the pain is severe or if it comes on suddenly, you must immediately consult a doctor. Another reason to consult a doctor is if the pain persists for more than 24 hours. If the pain is accompanied by black or bloody stools or vomiting and nausea, do not ignore it. Black stools are often an indicator of the presence of blood in the digestive tract. Abdominal pain that worsens with movement or is tender to touch is also something that should be shown to a doctor. Other reasons to consult a doctor are abdominal pain with persistent vomiting following meals and unexplained weight loss and a loss of appetite.

The bottom line is, that when it comes to abdominal pain, it's better to consult a doctor and be told that there's nothing to worry about rather than self medicate and wait for it to worsen.

Abdominal Pain & When To Consult A Doctor

Ulcerative Colitis is a chronic inflammatory disease that affects the lining of the intestine and the rectum. It is located just above the anus. Patients suffering from ulcerative colitis tend to have small ulcers in their rectum and the colon. These eventually flare up leading to diarrhea, bloody stools, anemia and abdominal pain. The inflammation starts from the rectum and eventually, spreads to the colon. Ulcerative Colitis tends to flare up and remit in an alternate phase. The remission can last from few weeks to few years.

Methods adopted to diagnose Ulcerative Colitis-
Ulcerative Colitis is very similar to an inflammatory bowel disease known as Crohn s disease. The only differentiating factor is the fact that, ulcerative colitis affects the colon whereas, Crohn s disease affects the digestive system and the small intestine. A doctor might prescribe certain tests such as the colonoscopy, blood tests, CT scan, pill camera, stool sample tests etc.

Why is surgery necessary to treat Ulcerative Colitis?
An estimated 40 percent of all Ulcerative Colitis patients need to undergo surgery to recover completely. The reason surgery becomes necessary to treat ulcerative colitis are the following:

Drug therapy and medication become ineffective.
Without undergoing surgery, the condition might increase the risk of developing cancer.
The colon has the risk of getting ruptured if surgery is not performed on time.
There could be excessive bleeding.
Toxic megacolon might set in.
Types of surgery available to treat Ulcerative Colitis
A procedure where the entire colon is removed is known as the colectomy. In case both the colons are removed, the procedure is termed as proctocolectomy. In this procedure, an external pouch needed to be attached to the stoma that collects the stools. There is another method known as pouch surgery. 

Pelvic pouch or ileal pouch is also termed as IPAA. This procedure doesn t involve permanent stoma. In this procedure, both the colon and the rectum are eradicated from the body. The small intestine is then used to form a J-shaped pouch, that serves as the new rectum. The pouch is then connected to the anus. The whole procedure is done via two surgeries.

What are the surgical complications of this procedure?

There could be an excessive bowel movement.
There are instances where an inflammation of the pouch is observed. This condition is known as pouchitis.
There could be a situation of intestinal blockage from adhesion due to surgery.
There could be pouch failure that can happen inside within 5 few years. This is observed in 4 out of 100 patients who are treated. In this case, the patient should go for a permanent ileectomy.

Ulcerative Colitis - What You Need To Know?

Any type of surgery is stressful for your body and you will need to take extra care of yourself in order to heal well. Any procedure that is performed on the stomach, liver, gallbladder, intestines, appendix, pancreas or spleen can be categorised as an abdominal surgery. 

Here are ten tips to speed up the healing process after such a surgery.

Be prepared: While preparing yourself for surgery, also prepare your home for your return after surgery. Stock up your fridge with soft foods and keep loose, comfortable clothes easily accessible. Ideally, finish your laundry and house cleaning before the surgery and move away furniture and other things that could trip you.
Understand your medication: After the surgery, you are likely to be prescribed medication to relieve the pain and help with the healing process. Understand the dosage of these medications as well as any possible side effects that you should watch out for.
Get out of bed: The more you move around, the faster your incision will heal. Moving about also aids in the digestive process and helps the bowel work efficiently.
Avoid lifting heavy weights: Do not lift anything heavier than 500 grammes without your doctor s consent. This includes your pets, laundry baskets, grocery bags etc. also, avoid vacuuming for a while.
Get some light exercise: It may be a few months before you can get back to your regular workout routine but ensure that you get a little light exercise every day. Walking is a great way to start.
Keep plenty of pillows at hand: Holding a pillow between your knees or against your stomach can help relieve abdominal pain and discomfort. You may also feel better by propping yourself up on a few pillows when sitting on a chair.
Drink plenty of water: Keeping your body hydrated is crucial to the healing process. Water aids in circulation and ensures that adequate nutrients reach all parts of your body. Ideally, one should drink 8 to 10 glasses of water a day.
Care for your incision: Keep your incision clean and dry by washing it with soap and water daily and thoroughly drying it afterwards. Do not apply any ointment or cream on the area unless advised so by the doctor.
Take a close look at your diet: For the first few days, it is advisable to eat only soft or semi-soft foods that are easy to digest. You may gradually change to normal food as your body s tolerance levels increase.
Get plenty of sunshine: Exposing yourself to a little sunshine on a daily basis can make the recovery process less painful and make you more cheerful.

10 Quick Tips To Help You Recover Post Abdominal Surgery!

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