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Pancreas and the problem

Surgical Abdominal IncisionsDefinitionsIncision: A cut produced surgically by a sharp instrument that creates an opening

into an organ or space in the body.Abdomen: The part of the trunk that lies between the thorax and the pelvisIncision selection- Accessibility - Extensibility - Security

Note: The incision must not only give ready and direct access to the anatomy to be investigated but also provide sufficient room for the operation to be performed. The incision should be extensible in a direction that will allow for

any probable enlargement of the scope of the operation, but it should interfere aslittle as possible with the functions of the abdominal wall.In the planning of an abdominal incision, the following factors must be takeninto consideration :

Preoperative diagnosis The speed with which the operation needs to be performed, as in

trauma or major haemorrhage. Previous abdominal operation.

The incision must be tailored to the patients need but is strongly influenced bythe surgeons preference.In general, re-entry into the abdominal cavity is best done through the previouslaparotomy incision. This minimizes further loss of tensile strength of theabdominal wall by avoiding the creation of additional fascial defectsIt is probably no exaggeration to state that, in abdominal surgery, wisely chosenincisions and correct methods of making and closing such wounds are factors of

great importance.

Any mistake, such as a badly placed incision, inept methods of suturing, or ill- judged selection of suture material, may result in serious complications such ashaematoma formation, an ugly scar, an incisional hernia, or, worst of all,complete disruption of the wound

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Layers of abdominal wallSkin (- Langers lines.Superficial fascia (Campers fascia (Fatty Layer) & Scarpa's fascia(Membranous Layer)Deep fascia (Connective Tissue Layer.)Muscles (Anterior group ( Rectus abdominis & pyramidalis) & lateralgroup ( External Oblique, internal oblique & transverses)Transversalis fasciaExtraperitoneal fasciaPeritoneum

RECTUS ABDOMINISOrigin : Symphasis pubis, pubic crestInsertion : 5 th, 6th and 7 th costal cartilage and xiphoid process.Nerve Supply : Lower six thoracic nerves.Rectus Sheath : made up of the aponeuroses of the three anterolateral abdominal

muscles as they converge at the linea alba.Linea Alba : fusion of the aponeuroses of the abdominal muscles, and it

separates the left and right rectus abdominis muscles.

External ObliqueOrigin : lower 8 ribs.Insertion : Xiphoid process, Linea alba, pubic crest, pubic tubercle, iliac crest.Nerve Supply : Lower six thoracic nerves, iliohypgastric n., ilioinguinal n.

Internal ObliqueOrigin : Lumbar Fascia, iliac crest, lateral two thirds of inguinal ligament.Insertion : Lower three ribs, costal cartilage, Xiphoid process, Linea alba,

symphasis pubis.Nerve Supply : Lower six thoracic nerves, iliohypgastric n., ilioinguinal n.

Transversus Abdominis

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Origin : lower six costal cartilage, lumbar fascia, anterior two thirds of iliaccrest, lateral third of inguinal ligament.

Insertion : Xiphoid process, Linea alba, symphasis pubis.Nerve Supply : Lower six thoracic nerves, iliohypgastric n., ilioinguinal n.