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 outcome and the procedure of an abdominal laparoscopic surgery vary among patients. The extent of the surgery, the length of the procedure, the surgeon, the hospital nursing staff, and a number of other factors vary with each patient.

Moreover, the recovery or the healing time also varies among patients. What applies to one patient may not apply to another. Generally speaking, surgeons will tell you that it takes only a few days to recover from a laparoscopic surgery, but this is not true to specific cases as in many cases, the recovery time has been longer than expected. So, a laparoscopic surgery is subjective to the health of the patient and the extent of the procedure; however, there are some tips that may prove to be helpful for you to deal with a laparoscopic surgery and to improve your healing process.

Here are some useful tips that you can follow before the surgical procedure.

After you have consulted your doctor and made up your mind on the procedure, then it will be useful to watch some surgery videos and read about the procedure to prepare yourself mentally. The videos can be gory and hence discretion must be maintained.
You can read blogs by patients who have undergone laparoscopic surgery to get a better understanding of the procedure and its implications.
Eight hours prior to the procedure, do not drink or eat anything.
Ask someone to accompany you on the day of the procedure.
Make sure that you fix a pre-op appointment with the surgeon to clear any doubts about the surgery, anesthesia or any such concern.
You can shave the part of your body where the surgery will be performed by yourself or be prepared for someone else to do the same at the hospital.
Prepare your hospital bag with the necessary items and inform the person accompanying you about the items in your bag.
Here are some useful tips that you can follow after the surgery.

Keep yourself active after the procedure to enhance the healing process and to relieve any flatulence.
Stick to comfortable clothing and preferably loose clothes.
Avoid taking a bath for a week or as advised by your surgeon.
To avoid constipation and to stay hydrated drink at least 2-3 liters of water a day.
Hold a pillow against your stomach to lessen the pain while sneezing or coughing.
Don t get up straight from your bed. Roll sideways and use the support of your arm to stand up.
Avoid driving for at least 2 weeks.
Go for regular check-ups with your surgeon or doctor to ensure that the incisions are healing properly.

Tips To Deal With Abdominal Laparoscopy!

Dyspepsia is an uncommon word, but a very common problem. This medical condition is more commonly known as indigestion of the stomach and small intestine. The symptoms of this condition include abdominal pain, bloating, belching, nausea and a loss of appetite. They come and go varying terms of frequency and intensity. 

Some of the common causes of dyspepsia are lactose intolerance, anxiety, regurgitated stomach juices, stomach ulcers, irritable bowel syndrome and excessive caffeine or alcohol intake. In most cases dyspepsia can be easily treated with home remedies. 

Here are the 5 best ways to treat it.
1. Lemon juice: Lemon juice cleanses the digestive system by flushing out waste material and undigested food. It also inhibits the formation of acids in the stomach and boosts appetite. Dilute the juice of 1 lemon in a glass of water to avail its benefits. You could also add half a teaspoon of fresh ginger juice to this. Ginger also aids in digestion and prevents flatulence.

2. Buttermilk: Buttermilk has cooling properties and helps calm the stomach and intestines. It is also suitable for people who are lactose intolerant. Drink a glass of buttermilk immediately after a meal to improve your digestion. You could also flavor it with roasted cumin powder or mint. Mint also helps in relieving indigestion and prevents buildup of gases in the stomach while cumin stimulates the secretion of pancreatic enzymes.

3. Yogurt: Yogurt is the best remedy for any stomach bug. It is rich in probiotics that help restore balance healthy gut bacteria and stabilize digestion. Yogurt can be had as an accompaniment to your meals or mixed with steamed rice to make it a meal in itself.

4. Fenugreek: Fenugreek boosts appetite and helps relieve indigestion. This herb is known for its soothing properties that cleanse the digestive system. Fenugreek leaves can be bitter and unpalatable. Hence, to benefit from this, boil the leaves and then lightly fry them in butter before eating them.

5. Pomegranate juice: Pomegranate juice is an excellent way to treat indigestion and diarrhea. Its antioxidant properties also make it a good remedy for heartburn. To benefit from pomegranate juice, dilute the juice of a pomegranate in a glass of water along with a tablespoon of honey.

Along with this, also take a look at your eating habits. Avoid eating on the move and chew your food properly. Eat only when you are hungry and control your portion sizes. Lastly, make the time to exercise for half an hour or so every day.

What Is Dyspepsia? 5 Best Ways to Treat It

In most cases, pain anywhere in the body can be explained as a symptom of some other problem, but sometimes, there is no reason for abdominal pain. This type of pain is known as chronic functional abdominal pain. This is a gastrointestinal disorder that cannot be explained through X-ray or laboratory findings. It can be triggered by altered sensitivity to nerve impulses in the brain and gut. People suffering from this condition are often so debilitated by the pain that it becomes the central focus of their life.

This condition cannot be cured, but with proper treatment, it can be managed so that it does not affect the quality of your life. The aim of treatment for this condition is to control the symptoms and improve functioning. When it comes to treating this condition, the patient s relationship with his or her doctor plays an important role as the condition cannot be proven through any form of testing and it has a great psychological effect on the person. Regular checkups are also a key to managing this condition effectively.

The first step towards achieving this is to identify possible emotional and situational triggers. Maintaining a journal that records these experiences can help with this. Further treatment is usually either through psychological treatment or antidepressants.

Psychological treatment is based on the understanding that the brain can block pain by diverting attention elsewhere. Nerve impulses that travel from the abdomen to the brain must pass through a type of  gate  that is controlled by nerve impulses generated by the brain. When these impulses close the gates, pain is blocked while when these gates are open, the pain can be magnified. Psychological treatment for chronic functional abdominal pain can be in the form of relaxation techniques, imagery, hypnosis and cognitive behavioral therapy. While relaxation techniques such as meditation and hypnosis help a person shift focus from the pain, cognitive behavioral therapy teaches a person how to change thoughts and perceptions in order to control the pain.

Antidepressants can also act as pain relievers. This form of medication stimulates the production of brain signals that close the  gates  of nerve transmissions. This blocks the pain but can take several weeks to be effective. Some people may experience side effects such as drowsiness and nausea and hence should never be taken without a doctor s supervision. In some cases, antidepressants may also be combined with cognitive behavioral therapy or medication to regulate bowels.

Ways to Treat Chronic Functional Abdominal Pain!

Everyone can suffer from pain in the stomach, at one time or the other and we usually ignore it. But when the pain is sudden and severe abdominal pain then it is termed as acute pain and this should not be ignored.

Often the following can be expected with acute pain:

Acute abdomen pain is usually synonymous with rapid onset of the symptoms which might indicate life threatening intra-abdominal pathology.
Pain is just a feature and not necessary that it is present at all times. An acute abdomen which is pain free usually occurs in children and women who are in their third trimester of pregnancy.
The differential diagnosis is difficult and wide especially in primary care. This is because the different organs within their peritoneal cavity might have different areas of referred pains.
Abdominal pain usually happens to be in the top three symptoms when patients present their state in the emergency and accident departments. But only few of these have acute abdominal pain.
Management of the abdominal pain should be the primary focus and an assessment should be done to reach the differential diagnosis so that care can be given accordingly.
The clinical evaluation regarding abdomen pain can change quickly. Any diagnosis which had been made can change and both doctor and patient should not be hesitant and seek other treatment.
Conditions which might cause acute abdomen pain are:

Meckel's diverticulitis or Acute appendicitis
Acute cholecystitis
Ectopic pregnancy
Acute pancreatitis.
Peptic ulcer disease
Diverticulitis.
Intestinal obstruction, including paralytic ileus (adynamic obstruction)
Pelvic inflammatory disease.
Gastrointestinal (GI) haemorrhage
Gastroenteritis.
Acute intestinal ischaemia/infarction or vasculitis.
Acute urinary retention
Renal colic or renal tract pain
Testicular torsion
Abdominal aortic aneurysm
Non surgical diseases like pericarditis, sickle cell crisis, acute intermittent porphyria, HIV-associated lymphadenopathy, bowel disease, typhoid, opiate withdrawal, enteritis, pneumonia, myocardial infarction and hepatitis.
Rare causes might include thromboemboli, phytobezoar, and phytobezoar
Diagnosis of abdominal pains:

Patients can be ordered to get their blood tests done. Also if need be then imaging can also be referred to them.
Following tests can be done to rule out the condition causing the abdominal pain:
Blood Tests: these include FBC, LFTs, glucose, amylase, clotting, calcium and arterial blood gas for pancreatitis
Crossmatch or group and save
Pregnancy test in women of childbearing age
Blood cultures
Peritoneal lavage in case of an abdominal trauma
Urine analysis
X ray of the abdomen, ultrasound, CT scan
ECG and cardiac enzymes
Laparoscopy should be a routine procedure

Don't Ignore the Acute Abdominal Pain

As soon as one is released from hospital after going through an abdominal surgery, the patient must make a checklist and an early recovery strategy before leaving home. Do follow the following tips and recover soon.

Do make prior arrangements for a safe and comfortable journey back to home. Ensure that you have made transportation arrangements to go home safely. Use your own car or book any cab or take any friend s help. Place a cushion over your abdomen to keep it safe from jerks.

Do go for post-surgery checkup. Book an appointment with your surgeon post-surgery. This would ensure that surgery did not cause any side-effect.

Understand the schedule for taking medicines. Usually the patients are given painkillers. If you think you are not getting relief from it then ask your surgeon to prescribe you an alternative. Patients are likely to suffer from constipation post an abdominal surgery. If that happens, intake more fibrous food, fluids and indulge in light physical activities. Patients can also ask for cheaper alternative medicines.

Check for certain signs and symptoms and take adequate steps:

Take adequate sleep. There are chances that you may feel dizzy and fatigue, therefore one must observe change in sleep patterns. Have patience. Things will become normal in due course of time.

You will also be subjected to little pain from the incision. Take your medicines as directed in order to get an early relief from pain.

Draining of yellow color liquid from the incision in little quantities post the surgery is normal. If the drainage continues even after 7 to 14 days with redness around incision, it is a clear symptom of infection. Consult your surgeon immediately for the cure.

Removal of urinary catheter from the bladder may cause minor difficulties during urination. Situation will become normal in few days. If discomfort persists, consult your surgeon.

Identify the following dangerous symptoms and call your doctor right away.

Persistent vomiting or nausea

Incapability to digest food or fluids

Swelling in leg

Abnormal body temperature

Infection at the surgical site

Maintain a healthy and supervised lifestyle post surgery.

It will take few days to return to your normal routine life. So have patience until then.

Go for morning and evening walks. Avoid heavy exercises as such activities may cause physical strain.

Take care of your surgical incision

Surgical incision should be regularly cleaned or washed gently. Try to keep the surgical site dry until the stitches are removed.

After 5-7 days of surgery, the stitches would be removed by the surgeon. Avoid putting ointment on the stitches until then. It will take few weeks for the scars to fade.

Under proper care and supervision, the patient will soon recover post an abdominal surgery and will be able to get their life back on track.

Abdominal Surgery - Tips To Recover From It!

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