Abdominal Incisions

Before performing an incision in the abdominal wall, the gynecologic surgeon should have anticipated the type(s) of surgical procedure that will be done and possible complicating aspects associated with the operation. Consideration should be given to how far cephalad from the pelvis the operative exposure will need to be. In addition, the surgeon should weigh the cosmetic desire(s) of the patient, the urgency of the surgery, the patient’s history of previous laparotomies, and the risk of postoperative wound dehiscence.

Knowledge of pelvic anatomy of the anterior abdominal wall is essential to avoid or secure major vessels, to enhance appropriate repair so as to reduce the risk of incisional hernia or wound dehiscence, and to facilitate smooth entry. Practically, incisions may be categorized as midline or transverse. Transverse incisions may be further subdivided into muscle-splitting and muscle-cutting varieties.