The retroperitoneum is entered and the peritoneum and retroperitoneal fat are swept anteriorly. The retroperitoneal approach to the lumbar area is frequently used for aortic surgery, nephrectomy, lumbar symphathectomy, and ureterolithomy. Anterolateral thoracoabdominal incision. The skin around the cut (incision) is red or swollen. 10-10B). Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. 10-14). Disadvantages of a vertical incision include: Mediocre cosmetic results Higher infection rates, operative time, and hemorrhage with a paramedian incision Wound dehiscence (separation of the edges of wounds) and hernia may be common Oblique incisions are of two types: A left sided (L-shaped incision) can be created for left upper quadrant exposure. These could be symptoms of an infection. . The primary alternative to these transverse incisions is the vertical midline incision, which is unparalleled for extensibility and access to all aspects of the abdomen (see Chap. You can expect some pain and soreness once the anesthesia wears off. An advantage of this incision is that it affords a cosmetic closure because it is placed in a skin crease at the level of the belt line; however, exposure may be somewhat limited. Experts believed an incision would heal better than a natural tear. Routine episiotomies are no longer recommended. Disadvantages include the risk of injury to the ilioinguinal and iliohypogastric nerves. (Reproduced with permission from Baker RJ, Fischer JE: Mastery of Surgery, 4th ed. Types of episiotomy incisions. Once free, the rectus muscle is retracted laterally. Furthermore, prospective and randomized studies have shown little, if any, difference in the incidence of dehiscence and hernias between longitudinal and transverse incisions.6-8. If you're planning a vaginal delivery, here's what you need to know about episiotomy and childbirth. B. Paramedian incision in transverse section. Alternatively, when superior exposure of upper abdominal organs (eg, the esophagogastric junction) is required, thoracoabdominal incisions may be used. Right lower quadrant extraperitoneal approach to the iliac vessels, ureter, and bladder. 7. You might take prescription medications or use a nonprescription pain reliever or stool softener. Join the Geeky Medics community: Kolb et al found that electrosurgery was an independent risk factor for wound complications following surgery for ovarian cancer.4 However, Franchi and colleagues reported no difference in the rate of wound complications between scalpel and diathermy in patients who underwent mid-line abdominal incisions for the treatment of uterine cancer.5. Disadvantages include the risk of injury to the ilioinguinal and iliohypogastric nerves. Left lumbar approach to the retroperitoneum. An episiotomy is performed during a vaginal delivery. Positioning is aided by the use of a bean bag. Chapter 6. Incisions, Closures, and Management of the Abdominal Wound Additional considerations include certainty of diagnosis, speed of entry, body habitus, presence of previous scars, potential for problems with hemostasis, and cosmetic outcome. 00:00 Introduction Theoretical decreased risk of herniation; Improved lateral exposure; Disadvantages. 2. If the pleura is inadvertently injured, the resulting pneumothorax is handled at closure by insertion of a large-bore rubber catheter into the pleural cavity that is brought out through the wound. You've been pushing for too long or can't control pushing. This classically corresponds to the area of maximal tenderness on clinical examination when the appendix has become sufficiently inflamed to cause localised peritonitis.