A transverse incision runs across the body to provide access to the abdomen and pelvis. This horizontal incision can vary in length and placement, depending on the specifics of the procedure. An alternative to the transverse incision is the midline or vertical incision, which runs down the body. There are benefits and drawbacks to both types and the ultimate choice may depend on the surgeon’s personal preferences.
Clinical evidence suggests that transverse incisions can be less painful for patients, which can be an important consideration with abdominal wounds. Recovery can be limited by experiences of pain, especially if the patient is so uncomfortable that it is hard to get active. Failing to move around, even if it just involves walking with assistance on a surgical ward, can increase the risk of blood clots and hematomas after surgery.
In addition, the transverse incision can be more aesthetically pleasing. A careful surgeon may place it below the hairline or lower than the patient’s waist to ensure that it will be less visible. These incisions can also be less prone to strain, rupture, and herniation, major concerns with big abdominal wounds. These benefits can be considered when evaluating how to approach an open abdominal surgery where it is necessary to make a large cut to access the interior of the body.
One significant drawback of the transverse incision is that it can limit the ability to explore the upper abdomen if it is too low, or the lower abdomen if it is too high. The surgeon’s placement needs to consider the type of surgery to make sure all necessary tissues can be accessed. For something like a bowel resection, for example, the surgeon might want to be able to check the rest of the bowel for problems before packing the wound and closing the incision. This could be harder to do with a horizontal incision that lies low on the abdomen.
Blood loss can also be increased with this incision type. Patients may require transfusion as part of surgery and can bank blood ahead against this eventuality, but there may be cases where surgeons are concerned about increasing the risk of blood loss. If the patient might be more prone to complications with a transverse incision, the surgeon might recommend a vertical approach to limit blood loss as much as possible during the procedure, depending on the type of surgery and the approach. The best option can ultimately depend on the surgeon’s experience and the specifics of the patient’s case.