Paramedian Laparotomy

Urologic Indications for a Paramedian Laparotomy

Extraperitoneal approach to the distal and mid ureter.
Transperitoneal access to the lower abdominal cavity, as an alternative to a median laparotomy

Patient positioning: supine position with slight hyperextension of the lumbar spine
General anesthesia
Perioperative antibiotic prophylaxis, if the urinary or gastrointestinal tract is entered or if risk factors for a wound infection are present.

Paramedian skin incision [fig. paramedian laparotomy
Paramedian incision of the ventral lamina of the rectus sheat
Separation of the tendinous intersections from the ventral lamina of the rectus sheat and preparation of the medial boundary of the rectus muscle
The rectus muscle is pulled to the lateral by a retractor
Extraperitoneal approach: paramedian incision of the fascia transversalis (below arcuate line) and posterior lamina of the rectus sheat (above arcuate line) without incision of the peritoneum. The peritoneum is dissected to the medial beginning from caudal after developing the Retzius' space.
Transperitoneal approach: paramedian incision of the posterior lamina of the rectus sheat together with the peritoneum.

Paramedian laparotomy: skin incision 3–5 cm of the midline

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

You did not find what you are looking for?

Search this site with Google:

Custom Search

Last update

Dr. med. Dirk Manski
man...@urologielehrbuch.de