8.1 and 8.2 show the vascular and nervous supply to the abdominal wall muscles. Due to its continuation with Langers lines, the Lanz incision produces much more aesthetically pleasing results with reduced scarring. [QxMD MEDLINE Link]. RF2GJF00A - Nylon stitches in Kocher's incision and lower midline incision scar at abdomen of elder woman. [27] A number of these procedures were complicated by fascial dehiscence, with concomitant increases in costs, hospital length of stay, additional interventions, and associated complications. Results. Abdominal Wall Incision - Kocher - How to approach the - YouTube Common instruments include the camera, cutting and dissecting scissors, and grippers. Surgical Abdominal Incision.ppt - Surgical Abdominal Incisions DR S 31 (3):104-14. J Trauma Acute Care Surg. Limited midline incisions are also employed to assist laparoscopic cases such as bowel resections, where the dissection and mobilisation of the specimen to be excised are performed laparoscopically but then a larger port is required for retrieval. 67-79. The anterior rectus sheath is separated and moved laterally, before the excision is continued through the posterior rectus sheath (if above the arcuate line) and the transversalis fascia, reaching the peritoneum and abdominal cavity. Abdominal incisions: techniques and postoperative complications 317 over,exposureoftheabdomenisexcellent.Exten-sions,whenrequired,caneasilybemadesuperiorly The subcutaneous tissue is then separated in the midline and the linea alba is exposed. Kocher/Subcostal Incision The Kocher incision is a subcostal incision on the right side of the abdomen used for open exposure of the gallbladder and biliary tree. Abdominal Incisions - Lanz - Kocher - Midline - TeachMeSurgery Last updated: August 23, 2022 2016 Jul. The Joel-Cohen incision is widely used by obstetricians. In a randomized controlled trial from 2019, conducted on 300 consecutive patients undergoing emergency midline laparotomy, Bansiwal et al found that patients whose laparotomies were closed by suturing the rectus sheath with 1-0 polydioxanone in a continuous layer had a significantly higher rate of burst abdomen (20.1%) than those whose laparotomies were closed with 1-0 polydioxanone in an interrupted layer (5.4%). Roughly one-third to halfway between the umbilicus and the pubic symphysis lies the arcuate line (of Douglas), which is the point at which the posterior elements of the sheath perforate to join the anterior sheath and leave the thickened transversalis fascia in direct contact with the rectus muscles. The incision is made to run parallel to the costal margin, starting below the xiphoid and extending laterally. [QxMD MEDLINE Link]. Medscape Education, Invasive Group A Streptococcus Outbreaks Associated With Home Healthcare, England, 20182019, encoded search term (Abdominal Closure) and Abdominal Closure, Pressure Injuries (Pressure Ulcers) and Wound Care. Skin incision. [Full Text]. Kocher Manoeuvre A wide Kocher maneuver is next performed with leftward reflection of the duodenum and head of the pancreas which allows near complete exposure of the portal vein and associated structures. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. In liver surgery, the Kocher subcostal incision, i.e., the right subcostal oblique incision, is often used, which has the advantages of hepatic mobilization and vascular control. It is an optimal way for emergencies, as opening the abdomen should not take longer than 40-60 seconds. Surgical Incisions Their Anatomical Basis Section: Thoracic Incisions: H. J. Pfannenstiel. The. Wound infection occurred in 12 group A patients and 10 group B patients, wound dehiscence in two group A patients and no group B patients. [QxMD MEDLINE Link]. Eur J Surg. Optimal exposure in pediatric abdominal surgery can be achieved by a transverse incision due to the abdominal proportions of the infant. No significant difference was noted regarding analgesia requirements and early postoperative complications. An oblique incision made in the right lower quadrant of the abdomen, classically used for. Frontiers | Case report: Pylorus-preserving pancreatoduodenectomy for [QxMD MEDLINE Link]. Maingot's Abdominal Operations. . The aponeurotic components of the sheath interdigitate in a thickened fibrous midline raphe between the two recti known helpfully as the linea alba (white line). Theyinvolve passing through all of the abdominal muscles, transversalis fascia, and then the peritoneum, before entering the abdominal cavity. Carney MJ, Weissler JM, Fox JP, Tecce MG, Hsu JY, Fischer JP. Management strategy for dirty abdominal incisions: primary or delayed primary closure? The inferior aspect of the fascial incision was grasped with Kocher clamps, elevated, and the underlying rectus muscles were . Harvin JA, Wray CJ, Steward J, Lawless RA, McNutt MK, Love JD, et al. The superficial nature of these hernias makes them amenable to diagnosis by ultrasonography. The incidence and nature of complications will be influenced by the patients comorbidities. Kocher's studies on one of his patients, who was operated on in 1874, led to an early discovery. 97), 1735-1756. The lower abdominal muscle splitting approach is often chosen in case of open appendectomy or for specimen retrieval during laparoscopic surgery. Epidermis, dermis, and subcutis, showing hair follicle, sweat gland, and sebaceous gland. Irvin TT, Stoddard CJ, Greaney MG, Duthie HL. 2009 May 15. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating conditions. However, this procedure would be associated with a risk of . Find the perfect midline incision stock photo, image, vector, illustration or 360 image. Many surgical procedures may now be performed laparoscopically with generally better results in terms of cosmesis, postoperative pain, recovery time and thus reduced length of stay and more expedient return to function when compared with traditional open techniques. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Controlled clinical trial of three suture materials for abdominal wall closure after bowl operations. A midline incision (see the image below) is the most commonly used route of access to the abdominal cavity 2009 Apr. kocher's incision layers - Huntingpestservices.com A Kocher incision is made parallel to the subcostal margin to access the underlying liver and biliary tree. Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair. JCM | Free Full-Text | Strategic Approach to Aberrant Hepatic Arterial Figure 1 Lanz (transverse) and Gridiron (oblique) incisions at McBurneys point. Hussain SA. Primary Low Transverse Cesarean Section Operative Sample Report Gupta H, Srivastava A, Menon GR, Agrawal CS, Chumber S, Kumar S. Comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials. [7, 18, 4, 3]. Surgical Exposures of the Elbow | Clinical Gate When the center of the incision has been reached, the same method is used on the opposite end of the incision. Emil Theodor Kocher - NobelPrize.org Share cases and questions with Physicians on Medscape consult. Application of Autogenous Dermis Combined With Local Flap This incision is just inferior and parallel to the subcostal margin. Kocher's incision: It is an incision made several inches below and parallel to the lower border of the front of the rib cage. [QxMD MEDLINE Link]. The paramedian incision (no. Evidence-based recommendations have been developed for the use of negative-pressure wound therapy (NPWT) in the setting of the open abdomen. The great advantage of the midline incision is the limited risk of bleeding as the incision is made along the avascular linea alba. Layer's to Open:- Skin Subcutaneous fat External Oblique apponeurosis External Oblique muscle Internal oblique muscle Transverse addominis Is our article missing some key information? The only controlled study that was performed showed no positive effect in the use of prophylactic retention sutures; in fact, patients receiving retention sutures had a greater amount of postoperative pain. same as proximal extension of Kocher approach; intermuscular: triceps (radial n.) and brachioradialis/ECRL (radial n.) d istal: posterolateral approach to the forearm (Thompson) extend skin incision distally, still aiming towards Lister's tubercle; develop ECRB / EDC interval to visualize distal extent of supinator; identify PIN and protect This cookie is set by GDPR Cookie Consent plugin. 2001 Apr. [QxMD MEDLINE Link]. A randomized trial. [Full Text]. In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an operation or procedure. Rahbari NN, Knebel P, Diener MK, Seidlmayer C, Ridwelski K, Stltzing H, et al. However, the . Patients should be cautioned to avoid lifting, pushing, or pulling anything heavier than 10 lb (~4.5 kg) and generally to avoid any type of straining (increased abdominal pressure) as much as possible for 4-6 weeks after surgery. Midline incision hi-res stock photography and images - Alamy A Pfannenstiel skin incision was then made with the scalpel and carried through to the underlying layer of fascia. Kocher extensile approach: the skin incision runs from the supracondylar ridge of the humerus (ca. The most commonly documented postoperative complication is incisional hernia, which occurs in approximately 9-20% of patients after an abdominal closure. - Radiation 02:45 Kocher elevator Kocher approach Kocher artery forceps Kocher biliary tract incision Kocher bladder retractor 2012 Farlex, Inc. All rights reserved. The skin is the largest and heaviest organ of the body. The lateral edges of the incisions remain medial to the internal oblique muscles. [19] Subcutaneous closure may be accomplished with absorbable suture in an interrupted or continuous fashion. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. McEvedy's incision McEvedy's original incision was a lateral paramedian incision which used to incise the rectus sheath along its lateral margin and gain access by pulling the rectus medially. General considerations. Since 1992 up to 2006, 1356 thyroidectomies were performed in our Unit. Andrew Howard, Theddy Slongo, Peter Schmittenbecher. The small-bite technique (in which the distance between the suture and the wound edge is reduced to 5-8 mm and the distance from stitchto stitch is reduced to 5 mm from the fascial edge) has been assessed in an experimental study Both of these conditions may result in lengths of bowel becoming trapped within the hernial sac (incarcerated), and the hernia may be sufficiently large or the defect through which it protrudes may be sufficiently tight to occlude intraluminal passage of bowel content (obstruction), venous outflow and later arterial supply (strangulation). The Kocher-Langenbeck approach is an approach to the posterior structures of the acetabulum. The incision runs 2-5cm lateral to the midline, cutting through the skin, subcutaneous tissue, and the anterior rectus sheath. Abdominal wound closure: current perspectives. 1981 Apr. [1] : Layered closure is sequential closure of each fascial layer individually. Staple closure is a viable alternative to suturing the skin. [QxMD MEDLINE Link]. The benefits of mass closure include decreased cost and decreased operating time. (if excising 11th rib, incise mm fibers on top down to bone, use periosteal elevator momving medial to lateral, use costal elevator to free rib posteriorly, clamp with Kocher and rib cutter, can . Am J Surg. Cengiz Y, Blomquist P, Israelsson LA. The midline incision (no. . Suture material is chosen. Bruhin A, Ferreira F, Chariker M, Smith J, Runkel N. Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen. Rink AD, Goldschmidt D, Dietrich J, Nagelschmidt M, Vestweber KH. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 167-92. 1999 Oct. 165 (10):958-61. The vascular supply to the subcutaneous tissue of the abdominal wall is limited, increasing susceptibility to soft-tissue infection. [Full Text]. Found an error? Facebook: http://www.facebook.com/geekymedics The Pfannenstiel incision is a firm favourite of obstetricians for accessing the gravid uterus for which a curvilinear incision is made through the skin and subcutaneous fat, then a longitudinal incision made in the linea alba. The key principles of making surgical incisions are: Once the operation is over, surgical excisions can be closedby sutures, staples, steri-strips, tissue glue, or a combination of these agents. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". - Associated symptoms 03:04 1. Kizy S, Ikramuddin S. Abdominal wall, omentum, mesentery, and retroperitoneum. Also well-known to all thyroid surgeons is the "Kocher incision", a transverse, slightly curved incision about 2 cm above the sternoclavicular joints. Smith JAR. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . . Brown SR, Goodfellow PB. generic complications of surgery vs those specific to the operation, and presenting as immediate, early or late complications. APPROACHESMidline incisionThis is the main approach for major abdominal surgery, central vascular (aortic), and abdominal trauma surgery. A midline incision will thus encounter the following layers of tissue: The scar of a paramedian incision may be seen running parallel to the midline in a limited number of patients but has fallen from common practice in favour of the midline incision due to its complexity and poor cosmesis. Laparoscopic surgery (keyhole surgery) requires small incisions to be made in the skin, which allow instruments to be passed into the abdominal cavity. A prospective multicentre study evaluating the outcomes of the No se cortan fibras musculares. It does not store any personal data. The external oblique aponeurosis is then closed with an interrupted or continuous absorbable suture (see the image below). [QxMD MEDLINE Link]. 2015 Dec. 210 (6):1126-30; discussion 1130-1. 2005 Oct. 92 (10):1208-11. These cookies ensure basic functionalities and security features of the website, anonymously. Wissing J, van Vroonhoven TJ, Schattenkerk ME, Veen HF, Ponsen RJ, Jeekel J. Fascia closure after midline laparotomy: results of a randomized trial. The dorsocranial articular acetabulum is also accessible either through the fracture gap or after a capsulotomy. Br J Surg. 2009 Apr. Some common incision sites are discussed below. There are still occasions where an open approach is required for speed, ease of access to relevant structures or in situations where laparoscopic equipment is unavailable. The caecum is delivered into the wound and, if the appendix is not immediately visible, it is located by tracing the taeniae coli along the caecumthey fuse . In continuous fascial closure, two Kocher clamps are clamped to the fascial layer midway through the incision and then retracted by the assistant. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. A paramedian incision can damage the muscles lateral blood and nerve supply, which may result in the atrophy of the muscle medial to the incision. Cesarean section (LSCS): Operative procedure - MedchromeTube [QxMD MEDLINE Link]. Stock photos, 360 images, vectors and videos Wound dehiscence more commonly occurs in the first 1-2 weeks following definitive fascial closure of the abdominal wall, during the early stages of tissue healing. (Kocher incision) is diagonal on one side of your upper abdomen (your . Disadvantages include patients experiencing more pain than they would from a transverse incision, particularly during deep breathing postoperatively, and the incision is perpendicular to the Langers skin tension lines resulting in poorer cosmesis. Often, having the assistant cross the. Nr. This cookie is set by GDPR Cookie Consent plugin. The sheath is bounded laterally by the linea semilunaris, which is the longitudinal margin at which the internal oblique aponeuroses bifurcate to form anterior and posterior leaves. Fistula (hole formation) Wound pain. Right Kocher's incision: a feasible and effective incision for right This type of incision offers little extensibility and less exposure than a Pfannestiel incision. The intercostal nerves emerge from below the costal margin and run between the layers of the internal oblique and transversus abdominis muscles. Various bridges, bumps, and bolsters are available to alleviate some of the tension the retention suture places on the skin surface. [30] ; more recently reported figures have been in the range of 1-3%. . George MJ, Adams SD, McNutt MK, Love JD, Albarado R, Moore LJ, et al. Br J Surg. [Full Text]. It can be difficult to identify precise intervals proximally because of confluence of fibers in the common extensor origin. [QxMD MEDLINE Link]. Eur J Surg. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. If nerves have been severed during the operation, this is most likely to become apparent over the following few days as the effects of anaesthesia wear off and the patient notices the deficit (or neuropathic pain). [QxMD MEDLINE Link]. This however is different from the same named incision used for the thyroid gland surgery. 13th ed. Incisional hernia did not occur in either group. Systematic review and meta-analysis of cutting diathermy versus scalpel for skin incision. It is mainly used to gain access for gall bladder and/or biliary tree pathology. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ This modification prevented the high incisional hernia rate. Theodor Kocher (1841-1917), Professor of Surgery in Berne, Switzerland. 2001 May. The incisions cut through layers of skin, body fat and fascia (connective tissue) until they reach the abdominal muscles. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 41 (3):57-60. The incision was closed in layers, and a drainage tube was used. Nobel Laureate in Medicine 1909 "for his work on the physiology, pathology and surgery of the thyroid gland" (Courtesy of Nobelprize.org) Full size image. The intent of this chapter is to provide an overview of body tissues, surgical incisions, and surgical site closure. With a Rockey-Davis incision, some benefit to closing the peritoneum has been shown. Kocher A Kocher incision begins inferior to the xiphoid process and extends inferolaterally in parallel to the right costal margin. DO NOT perform any examination or procedure on patients based purely on the content of these videos. We also use third-party cookies that help us analyze and understand how you use this website. A Kocher incision (no. Either a posterior skin incision with a lateral skin flap or a lateral skin incision can be used. Background [QxMD MEDLINE Link]. The incision will then pass through the all the rectus sheath and rectus muscle, internal oblique and transversus abdominus, before passing through the transversalis fascia and then peritoneum to enter the abdominal cavity. Membranes are ruptured by toothed or Kocher's forceps. Muscle herniation of the lower extremity, such as tibialis anterior muscle herniation (TAMH), is not a rare cause of leg pain in athletes. 2001 Mar. - Over 3000 Free MCQs: https://geekyquiz.com/ 2008 Jul. 2014 Oct. 12 (10):1105-14. Interrupted closure was associated with significantly less dehiscence than continuous closure , and no differences were found between the two methods with regard to hermia risk. Kocher incision | definition of Kocher incision by Medical dictionary Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The effect is to alleviate the tension on the primary suture line. When performing midline celiotomy, properly identifying the linea alba and avoiding paramedian abdominal wall incisions are key to avoiding incising the rectus abdominal muscle (Figure 1).An acceptable midline incision should be made directly through the linea alba or medial to the rectus abdominal muscles and maintained throughout the approach to avoid muscle damage. Right Kocher's incision: a feasible and effective incision for right [Full Text]. 2015 Dec 4. Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy. 212 (1):34-9. Negative side-effects of retention sutures for abdominal wound closure. A prospective randomised study. The assistant following the continuous closure should apply sufficient tension to approximate the tissue without strangulating it. 216 (1):56-59. Although in theory this may stand, a paucity of data exists regarding the significance of closing the subcutaneous fat. The incision is made to run parallel to the costal margin, starting below the xiphoid and extending laterally. [QxMD MEDLINE Link]. The tube has a tiny video camera and surgical tools. The abdominal cavity is an ovoid space bounded cephalad by the diaphragm and inferior thoracic margin, caudally by the pelvic brim, posteriorly by the lumbar spine along with quadratus lumborum, psoas major and iliacus, and anterolaterally by the retaining musculature of the abdominal wall. Wound healing. Luis G Fernndez, MD, KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS Professor of Surgery, Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, University of Texas Health Science Center; Clinical Assistant Professor of Surgery, Department of Surgery, University of Texas Medical Branch; Adjunct Clinical Professor of Medicine and Nursing, University of Texas; Adjunct Clinical Assistant Professor, Department of Medical Education Health Science Center, Adjunct Clinical Assistant Professor, Department of Physician Assistant Studies, School of Health Professions, University of North Texas; Medical Director, Trauma Wound Care, UT Health East; Member, ACS National Committee on Trauma; Vice Chairman, State Guard Association of the United States (SGAUS) Medical Academy; Commander Emeritus, Texas Commandery, MOFW; Brigadier General (Ret/HR), Past Commanding General, TXSG Medical Brigade/Medical Rangers The skin can be closed using various methods Neth J Surg. 32-9. ) is a subcostal incision used to gain access for the gall bladder the biliary tree. . This classically corresponds to the area of maximal tenderness on clinical examination when the appendix has become sufficiently inflamed to cause localised peritonitis. 2 (6083):351-2. 1977 Aug 6. Br J Surg. 249 (4):576-82. Chapters: Kocher arc incision: oblique incision for opening the knee joint Kocher incision: subcostal incision performed on the right side exposes the gallbladder and common bile duct, and on the left side gives access to splenectomy or splenorenal venous anastomosis. New York: McGraw-Hill; 2016. The Kocher interval is between the extensor carpi ulnaris and the anconeus. PDF Posterior Rectus Sheath Hernia TikTok: https://www.tiktok.com/@geekymedics Arch Surg. Closure of a Kocher subcostal incision requires closure of the anterior and posterior rectus sheaths. Perioperative Antirheumatic Drug Guideline Contains Caveats, 8-Week TB Treatment Strategy Shows Potential, Physicians of the Year 2022: Best and Worst, Clinical Approach to Chronic Wound Management in Older Adults. A Kocher (subcostal) incision is commonly performed in the right upper quadrant for open cholecystectomy. Cochrane Database Syst Rev. Mass closure is continuous fascial closure with a single suture. Kustners incision A transverse incision is made 5cm above the symphysis pubis but below the anterior iliac spine. Disadvantages include the risk of injuring the superior epigastric vessels, and lateral extension of the incision risks disruption of intercostal nerves. ) is used for a wide array of abdominal surgery, as it allows the majority of the abdominal viscera to be accessed. The pyramidalis muscles are typically left attached to the aponeurosis. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk2MTc4OS10ZWNobmlxdWU=, Those with increased tension on the incision, Early planned reexploration of the peritoneal cavity, Unacceptable abdominal wall tension with conventional closure, Intraoperative instability necessitating a rapid temporary closure. Excessive tension leads to tissue necrosis and eventual failure of the closure. This incision may be modified to follow the horizontal Langers lines for improved cosmesis. - Timing 03:23 Disadvantages include disruption of the innervation to the rectus lying medially. A midline incision will thus encounter the following layers of tissue: Skin Subcutaneous fatty layer (Camper's fascia) Membranous fascia (Scarpa's) Linea alba Transversalis fascia Preperitoneal fat Parietal peritoneum Paramedian incision 2019 Mar. A surgical incision is an aperture into the body to permit the work of the operation to proceed. Trends in open abdominal surgery in the United States-Observations from 9,950,759 discharges using the 2009-2013 National Inpatient Sample (NIS) datasets. Kocher-Langenbeck approach to the acetabulum - AO Foundation [QxMD MEDLINE Link]. A collection of surgery revision notes covering key surgical topics. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ [1] ; however, a few consensus techniques are generally used. As well as obtaining significant exposure of the viscera, this incision causes minimal blood loss or nerve damage, and can be used for emergency procedures. [Full Text]. The internal oblique and transversalis muscles should be subsequently closed in a single layer with interrupted or running suture. The rectus muscles are separated and the incision is made in the midline. Saturated dressings should be changed when noted. Harvin JA, Sharpe JP, Croce MA, Goodman MD, Pritts TA, Dauer ED, et al. Abdominal Incisions and Anatomy of the Abdominal Wall This approach is commonly used for procedures requiring emergency laparotomy, such as in faecal peritonitis secondary to malignant intestinal perforation or in cases of ischaemic bowel. They recommended that either a figure-eight or a double horizontal mattress technique be employed to yield a secure repair. In doing so, three essentials should be . and the abdominal wall is closed in layers, except atthe lower angle of the incision, a small . - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Medical Dictionary for the Health Professions and Nursing Farlex 2012 Kocher, E. Theodor, Swiss surgeon and Nobel laureate, 1841-1917. Mkel JT, Kiviniemi H, Juvonen T, Laitinen S. Factors influencing wound dehiscence after midline laparotomy. Anatomy of Appendix and Appendicitis - Medchrome The Lanzincision is a transverse incision, whilst theGridiron incision is oblique (superolateral to inferomedial). 5. . 2018 Jul. The data seem to suggest that there is no difference between continuous and interrupted fascial closure in elective cases. When the two ends are within 1 cm of each other, they are tied with six to 10 knots. : a strong forceps for controlling bleeding in surgery having serrated blades with interlocking teeth at the tips. The rectus abdominis muscle is supplied by the superior It is appropriate for certain operations on the liver, gallbladder and biliary tract. But opting out of some of these cookies may affect your browsing experience. [17] The use of prophylactic mesh in high-risk patients, in comparison with primary suture closure of the midline incision, yielded a significant reduction in the incisional hernia rate.