The abdominoinguinal incision: The equivalent of thoracoabdominal incisionfor the lower quadrants of the abdomen

In the past, tumors of the iliac fossa, those of the area of the external i liac vessels, and those fixed to the wall of the lesser pelvis with extensi on into and involvement of the pubic bone were often considered unresectabl e through the conventional surgical incisions or were treated with hemipelv ectomy. For such tumors, although there was exposure of the cephalad aspect through routine incisions, there was lack of exposure on the caudal or lat eral aspects, which often extended anteriorly to involve the lower abdomina l wall or continued behind the inguinal ligament or through the obturator f oramen into the thigh. The abdominoinguinal incision provides exposure for resection of the majority of these rumors with preservation of the extremit y. It involves a lower midline incision, which is extended from the pubic s ymphysis transversely to the midinguinal point on the affected side and the n vertically for a few centimeters in the femoral triangle. The femoral ves sels 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 the ir 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 sid e of involvement in their continuity with the femoral vessels. With improve d exposure and vascular control, the majority of tumors with lateral pelvic fixation become resectable. (C) 1998 Wiley-Liss, Inc.