ResidentNet/clinical/Upper Midline

Type of Incisions: Upper Midline
Contributed by Mika Sinanan, MD
and his staff at the University of Washington Medical School

The upper midline incision provides access to the esophagus, hiatus, stomach and duodenum, pancreas, and hepatobiliary system. If extended, it allows major hepatic resection, adrenalectomy, and splenectomy.

Midline incisions are the most versatile incisions because easy extension superiorly or inferiorly allows access to all parts of the abdominal and retroperitoneal space without difficulty.

Upper midline incisions are very painful and restrict pulmonary function, particularly vital capacity, by about 50 percent. Pulmonary problems, especially in patients with a history of lung disease, prior pneumonia, emphysema, etc. are common after an upper midline incision, so the subcostal incision is preferred by many surgeons.

Video Resource: Incisions, Donald G. Gallup, M.D. 1991 (VHS 28 minutes) available from Ciné-Med's ACS/USSC Educational Library (General Interest Topics)

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