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Two types of incisions are typically used for doctors to access the lower abdominal cavity, either to perform a Cesarean section delivery or for other types of elective or exploratory surgery. These cuts might be horizontal, also known as a transverse or Pfannenstiel incision, which runs from side to side at just below the waistband. A mid-line, or vertical incision, runs from just below the navel to the pubic region, offering access to the same muscles and organs beneath.
According to a 2003 study by University of Heidelberg Medical School, published online at the National Institutes of Health Web site, about 90 percent of abdominal incisions up to that point used the vertical incision method at that German hospital. The study, however, revealed that there was no difference in infection, hernia, pain or other complications between the two methods. Due to this doctors were advised to begin allowing patients to decide if they would rather live with a transverse or a vertical incision scar.
One of the more common reasons surgeons must enter the abdominal cavity is to perform a Cesarean section, pulling the newborn from the uterus via the gut and not the vaginal cavity. Hernia repair, tumor removal, organ transplants and hysterectomies are more common reasons men and women must undergo a vertical incision. Depending on the procedure, a doctor may recommend one incision over another. The vertical cut is known to offer the best access to the entire pelvis, but it also leaves a deeper scar. On the other hand, the transverse cut is more discrete, leaves a more subtle scar, and offers just enough access for a baby to come out or a surgeon's instruments to enter.
Several complications can result from open-abdomen incisions, either transverse or vertical. These are not confined to the obvious infections and pain. Complications also could include hernia, clotting, pulmonary difficulties or internal bleeding. These problems are not confined to lower abdominal incisions, either. About a dozen types of incisions are used by abdominal surgeons to access different organ groups — each of which is liable to become infected or develop other more serious complications.
The initial vertical incision clears a path through skin and adipose tissue to reveal a thin layer of muscle and organ system beneath. Typically, surgeons attempt to avoid cutting muscle, which will take the longest to heal and produce the greatest long-term pain. Luckily, the muscle can typically be stretched apart, allowing access to the organs below. In some cases, however, there is no choice but to cut muscle and repair it later.