The abdominoinguinal incision: the equivalent of thoracoabdominal incision for the lower quadrants of the abdomen.

Abstract

In the past, tumors of the iliac fossa, those of the area of the external iliac vessels, and those fixed to the wall of the lesser pelvis with extension into and involvement of the pubic bone were often considered unresectable through the conventional surgical incisions or were treated with hemipelvectomy. For such tumors, although there was exposure of the cephalad aspect through routine incisions, there was lack of exposure on the caudal or lateral aspects, which often extended anteriorly to involve the lower abdominal wall or continued behind the inguinal ligament or through the obturator foramen into the thigh. The abdominoinguinal incision provides exposure for resection of the majority of these tumors with preservation of the extremity. It involves a lower midline incision, which is extended from the pubic symphysis transversely to the midinguinal point on the affected side and then vertically for a few centimeters in the femoral triangle. The femoral vessels are exposed, the ipsilateral rectus abdominis and anterior sheath are divided off the pubic crest, the inguinal ligament is divided off the pubic tubercle, the inferior epigastric vessels are ligated and divided near their origin from the vessels, and the lateral third of the inguinal ligament is detached from the iliac fascia. This incision provides full exposure of the lower abdominal aorta, inferior vena cava, and iliac vessels on the side of involvement in their continuity with the femoral vessels. With improved exposure and vascular control, the majority of tumors with lateral pelvic fixation become resectable.