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What's a Better Incision?
August
21 ,
2008
I got a great question todsay, and it gave me a great new idea for a topc of discussion.
The queston was as follows:
For my upcoming hysterectomy for fibroids, I want to have a vertical rather than horizontal incision, which would be less damaging to my abdominal muscles. Why do surgeons insist onhorizontal cuts, and what is your opinion on this? Thank you
Dear Ms. A;
Your question is very interesting, and it gives me the opportunity to discuss with you a little bit about the choices that surgeons make regarding the type of abdominal incision that we make. It is especially interesting that you are a veterinary surgeon yourself, so you will understand what I am saying.
To make a long story short, here are the advantages of a vertical abdominal incision:
1) The exposure is better
2) It is easier to extend during the surgery if this becomes necessary to
do things that were unanticipated
3) It is easier and quicker to get into the abdomen that way (for example
- in emergencies)
4) It is less traumatic to the rectus muscles
Here are the advantages of a horizontal incision:
1) It tends to heal better
2) Most women find it more cosmetically appealing
3) It provides easy access to the pelvic organs
So it is interesting that you are asking for a vertical incision, while one of the main reasons why surgeons use the horizontal incision is because that it what their patients want!
I know that you are worried about the muscles, but a properly done horizontal incision is usually done as a "pfannenstiel" incision, which means that the rectus muscles are not cut , they are really pealed of the surrounding sheath, and pulled aside. Although this is more traumatic to the muscle then a vertical incision, the muscles should heal normally after the surgery is over.
If you discuss this with your surgeon, I can't imagine that he/she would refuse to do it vertically, unless there is something I am not aware of.
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