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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 (without noticeable benefits)

Preoperative Patient Preparation

• 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 surgical site infections are present.

Surgical Technique of a Paramedian Laparotomy

• 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 sheath 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 sheath (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 sheath together with the peritoneum.

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

References

  Deutsche Version: Paramediane Laparotomie