A median incision runs down the middle of the abdomen to provide access to internal organs, including those located in the pubic region. The paramedian incision, located just off the midline of the abdomen, is closely related. For some procedures, a surgeon may opt for an infraumbilical or superumbilical median incision, starting below or above the belly button, to access a smaller area of the abdomen. Surgeons consider all their options during surgical planning to decide on the best approach for a given case.
In the classic median incision, the surgeon cuts through the tendons located above the tough rectus abdominus muscles in the abdomen. These muscles help maintain the integrity of the abdominal wall and surgeons work around them with care to minimize the risk of injuries to the patient. As they dissect through tendon and muscle tissue, they can use clamps to hold structures back so they can clearly see the surgical site.
This type of incision is very invasive. Patients can have a long recovery after a median incision because it weakens the abdominal muscles and is often very painful. They may have trouble moving comfortably and can need to take stool softeners to make it easier to use the bathroom without pain. As with other surgical sites, there’s a risk of infection and inflammation, as well as dehiscence, where the edges of the wound start to pull apart under strain.
There are some alternatives to a median incision which a surgeon may consider before recommending this option. If possible, a surgeon might perform a procedure laparoscopically, through a series of small incisions to insert tools and a video camera to view the surgical site. By eliminating a large surgical incision, the doctor radically reduces healing time for the patient and also prevents scarring. In some cases, it is necessary to convert from laparoscopy to an open incision because of complications, like discoveries that cases are more complex than expected.
Patients caring for a median incision typically need to keep it clean and dry. They may be in the hospital for several days for early recovery, during which nurses can handle cleaning and dressing changes. Medical staff may provide instruction in how to care for the site. Patients will have reduced activity levels until the incision fully heals and they get medical clearance, which can take several weeks or months in some cases. Symptoms like heat, a foul-smelling discharge, swelling, or color changes at the site should be reported to a doctor for evaluation.