ABSTRACT
This chapter considers the general principles of abdominal access rather than providing a recommended incision for each individual procedure. In general terms, the older the child, the more specific the site of the incision can be, tailored for the individual procedure being performed. The muscle-cutting transverse upper abdominal incision is suitable for most operations in infants, except when access is required to the distal colon and rectum or other pelvic organs. The incision may be limited to one side of the abdomen or can be extended across the midline, dividing both rectus muscles. A subcostal incision and the bilateral subcostal or “rooftop” incision are both useful for access to the upper abdomen. The principles of incision and wound closure are the same for other abdominal muscle-cutting incisions. Laparoscopy is best understood as an alternate technique by which a surgeon can perform the same operation as is performed through an open incision.
