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Gibson Incision

Urologic Indications

In urology, a gibson incision is used for renal transplantation or as an extraperitoneal approach to the distal ureter with low morbidity.

Preoperative Patient Preparation

• Patient positioning: supine position
• General anesthesia
• Perioperative antibiotic prophylaxis, if risk factors for wound infection are present

Surgical Technique of a Gibson Incision

• Skin incision see fig. gibson incision
• The external oblique abdominal muscle is divided in direction of the muscle fibers.
• The internal oblique and transverse abdominal muscle are cut at the lateral edge of the rectus sheath in the area of their aponeurosis. Caudally, the lateral edge of the rectus muscle can be incised for a better approach.
• The inferior epigastrical vesses are transected between ligatures.
• With blunt dissection, the peritoneum is pushed off cranially and medially to expose the iliac vessels and ureter.

Gibson incision: the arc-shaped incision starts 2 cm medial to the spina iliaca ant. sup. and is continued to the lateral border of the rectus sheat (3 cm cranial to the inguinal ligament).

Wound closure:

Fascial closure in two layers with continuous running or interrupted sutures: first suture reapproximates the internal oblique and transverse abdominal muscle, second suture closures the external oblique abdominal muscle.

References

  Deutsche Version: Schräger Unterbauchschnitt nach Gibson