Paramedian incision

*Site:

As upper midline incision but away from midline by 1 inch .

*Indications:

1. Biliary system.
2. Duodenum.
3. Pylorus.
4. Hepatic flexure of the colon.
5. Kidney.
6. Spleen (left).
7. Stomach (left).
8. Splenic flexure (left).
9. Tail of pancreas (left).

*Layers open:

1. Skin & S.C.
2. Anterior rectus sheath 
3. Retraction of rectus muscle laterally.
4. Posterior rectus sheath.
5. Fascia transversalis.
6. Peritoneum.

N.B. posterior rectus sheath , Fascia transversalis & peritoneum are opened as one layer.

* Advantages:

- Safe

- Accessible.

- Extensible.

- No incisional hernia.