repairing abdominal muscles after surgery

Factual Questions
1

A friend’s wife had a baby last spring. The birth was via scheduled (i.e. non-emergency) C-section. My friend was telling me recently that the incision was horizontal rather than vertical; his understanding was that for emergency abdominal surgery, a vertical incision somehow provides more rapid access, but that a horizontal incision heals more easily and so is preferred for non-emergency abdominal surgery.

at which point I went :dubious:

A transverse (horizontal) incision necessarily transects the rectus abdominis; the stitches (and later, the scar tissue) that reconnect the two portions of muscle will be under heavy tension whenever the RA muscle flexes.

A median (vertical) incision separates the rectus abdominis into left and right halves at the linea alba, but since the main tensile action of the muscle appears to run between the pelvis and the ribs, the stitches/scar tissue that reconnect the two lateral portions of muscle should be under minimal tension whenever the RA muscle flexes.

Or at least that’s my perspective as someone who has no surgical training. So what’s the straight dope on this? What determines whether an abdominal surgery incision will be horizontal or vertical?

2

The skin wound is horizontal, and that allows it to be hidden in a natural crease, and have less distracting forces so it heals better.

The abdominal incision is always vertical, and through the linea alba. so that minimum muscle damage occurs.

3

Slight hijack because this reminded me of one of the weirdest compliments I ever received - during my c-section the surgeon asked if I had been doing ab exercises. I replied that I had been doing Pregnancy Pilates.

She said, “Yes, I can tell, your abs are very strong and developed.”

Umm…thanks?

now back on track

4

It’s called the bikini line incision or the Pfannensteil incision. It’s cosmetically less obtrusive and apparently heals faster .

It’s better for lower pelvic situations as access is poor to the rest of the abdomen .