The Pfannenstiel incision is favored by obstetricians because it allows for easy access to the gravid uterus via a curved incision through the skin and subcutaneous fat and a subsequent longitudinal incision in the linea alba. The general and urological surgeons also employ it for pelvic procedures including radical open prostatectomy and cystectomy.
Over the past decade, the Pfannenstiel incision has risen in popularity among cosmetic surgeons. This is especially true for younger women undergoing gynecologic and pelvic surgery for benign conditions. If properly implanted, it is usually hidden by regrowth of pubic hair. The goal of the procedure is to make a cosmetic incision in the pelvis to facilitate pelvic surgery.
Definition:
The Pfannenstiel incision is typically described as a lengthy, horizontal abdominal incision that extends through the rectus abdominis muscles’ sheath but not through the muscles themselves, which are divided along the direction of their fibers.
Pfannenstiel Incision Location
Pfannenstiel incisions are skin incisions that are made in a horizontal direction over the symphysis pubis (also known as the pubic bone). This is the most common form of skin incision made during a cesarean section, and it is also known as the “bikini cut.” It is a type of surgical incision made in the abdomen that allows access to the abdominal cavity. Cesarean sections, along with other gynecological procedures, are currently performed using this method. This incision is also used in orthopedic treatments that use the Stoppa technique to heal pelvic fractures. An incision is made in the patient’s skin approximately 2 centimeters above the symphysis using the Pfannenstiel method.
This incision is performed horizontally above the pubis. Both the linea alba and the anterior rectus sheaths are divided and then reflected upward by 8-10 centimeters. The transversalis fascia and the peritoneum are both cut along the midline, and the rectus muscles are then retracted laterally.
Pfannenstiel Incision Steps
This operation can be performed with the patient in lithotomy, supine, or modified dorsal supine lithotomy. The steps are:
- Pfannenstiel incisions are semicircular and are made just above the mons pubis over a distance of around 12 centimeters. Before accessing the peritoneal cavity, it is critical to confirm that hemostasis is complete. The rectus fascia is then transversely opened.
- Following the opening of the rectus fascia, the rectus muscles are separated and dissected from the peritoneum. If lateral retraction is unable to sufficiently separate the rectus muscles, they are supposed to be transected. Patients who have previously gone through a term pregnancy have muscles that are, in general, easier to separate during surgery. Patients with particularly robust and contracted rectus muscles often require rectus muscle transection to gain appropriate exposure. The lateral border of the muscle contains the inferior epigastric artery and vein, which must be clamped, incised, and ligated before transecting the muscle.
- The peritoneum is picked up with tissue forceps and an incision is made either longitudinally or transversely.
Pfannenstiel Incision vs Low Transverse
The Pfannenstiel incision also called a bikini incision, entails making a horizontal cut in the lower abdomen right above the pubic bone. It is often used in gynecological treatments like C-sections and hysterectomies. This incision has several benefits, such as better cosmetic results due to its lower placement, less pain after surgery compared to vertical incisions, and a lower chance of incisional hernias. It may take longer in the operating room and be more difficult to execute on individuals who are overweight or who have significant scarring from previous surgery.
In contrast, a low transverse incision is an incision made horizontally across the lower abdomen, usually below the navel. It is frequently utilized in surgical operations such as appendectomies, pelvic surgeries, and lower-segment cesarean sections. In comparison to vertical incisions, the low transverse incision yields superior cosmetic results and significantly reduces the likelihood of wound problems. It also decreases postoperative discomfort. However, it may not allow adequate access in emergency procedures or circumstances where substantial exposure is required. Similar to the Pfannenstiel incision, this method carries a minimal risk of incisional hernias.