. Manual of operative surgery. ^ inches; then divide the right rectus ob-liquely and continue the cut downwards in the semilunar line. Method E.—Kochers oblique incision: Make an incision four inches inlength parallel to and about two inches below the right rib margin. Thisincision divides the outer fibres of the rectus muscle and portions of both the cio\ic<x- line of Iruri.^toTi-. Fig. 695.—{Gray, by permission from the British Journal of Surgery.) internal and external oblique. Branches of the intercostal nerves run acrossthe incision towards the rectus, and these must be retracted downw
. Manual of operative surgery. ^ inches; then divide the right rectus ob-liquely and continue the cut downwards in the semilunar line. Method E.—Kochers oblique incision: Make an incision four inches inlength parallel to and about two inches below the right rib margin. Thisincision divides the outer fibres of the rectus muscle and portions of both the cio\ic<x- line of Iruri.^toTi-. Fig. 695.—{Gray, by permission from the British Journal of Surgery.) internal and external oblique. Branches of the intercostal nerves run acrossthe incision towards the rectus, and these must be retracted downwards orupwards and preserved uninjured. Kochers incision gives very free accessto the biliary region, but necessitates an undue amount of muscle injury. Kocher also uses an incision which passes in the middle line from near theensiform cartilage to near the umbilicus and thence outwards through the rectusmuscle. Pannett modifies this cut as follows: A long paramedian rectussheath incision is made from about i inch below the ensiform cartilage to theumbilicus, and the abdomen opened in the usual way. Exploration is thenmade to ascertain whether exposure is adequate. If it is not, the anterior 566 OPERATIONS OX THE BILIARY PASSAGES rectus sheath is separated from the muscle and pulled outwards. The rectusitself is divided part of the way across, at a point midway between the en
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