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Pfannenstiel Incision

Urologic Indications for a Pfannenstiel Incision

• Extraperitoneal surgical approach to the prostate, bladder and distal ureters.
• The Pfannenstiel incision offers cosmetic advantages, but it cannot be extended easily in case of unexpected intraoperative situations.

Preoperative Patient Preparation

• Patient positioning: supine position with slight hyperextension of the lumbar spine
• General or spinal 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 Pfannenstiel Incision

• Skin incision see fig. pfannenstiel incision.
• Exposure of the ventral lamina of the rectus sheath and transverse division 2–3 cm cranial of the symphysis. The lateral border of the rectus sheath should be reached.
• The ventral lamina of the rectus sheath is dissected of the rectus muscle to expose the midline between the rectus muscles. Caudally, the pyramidal muscles remain with the ventral lamina of the rectus sheat.
• Division of the midline and fascia transversalis to separate both rectus muscles. Blunt dissection of the Retzius' space.
• Using blunt dissection, the peritoneum is pushed superiorly and medially to expose the iliac vessels, spermatic cord and ureters.

Pfannenstiel incision: skin incision

Wound closure:

Interrupted sutures vicryl 0 are used to reapproximate the rectus muscle. Fascial closure is done with the short stitch technique: continuous running suture size 0 or 2-0, tissue bites of 5 mm and intersuture spacing of 4--5 mm are applied exclusively to the fascia (anterior lamina of the rectus sheat).

References

  Deutsche Version: Pfannenstiel Zugang