Lanz Incision for Appendectomy
Overview and Technique
The Lanz incision is a transverse lower abdominal incision placed in the right iliac fossa, positioned more laterally than the traditional McBurney's point, running along Langer's lines to provide superior cosmetic outcomes while maintaining adequate surgical access for open appendectomy. 1
Anatomical Positioning
- The incision is made as a transverse cut in the right lower quadrant, typically 2-3 cm below and medial to the anterior superior iliac spine 1
- It is positioned more frequently over the base of the appendix compared to other incision types 1
- The incision follows the natural skin creases (Langer's lines), which contributes to better cosmetic healing 1
Surgical Advantages
Access and Feasibility
- Provides adequate access even in difficult appendectomy cases, making it particularly suitable for surgical trainees 1
- The transverse orientation allows for extension if needed during complicated cases 1
- Can be performed under local anesthesia using 0.5% lignocaine (3-4 mg/kg body weight) infiltrated superficially and into deeper planes 2
Cosmetic Benefits
- Results in a more cosmetically acceptable scar due to alignment with natural skin lines 1
- The transverse orientation is less visible than vertical incisions 1
Clinical Context
Current Surgical Landscape
While the Lanz incision remains a valid open approach, laparoscopic appendectomy is now strongly recommended as the primary surgical approach for acute appendicitis in both adults and children when equipment and expertise are available, due to superior outcomes in postoperative pain, wound infection rates, shorter hospital stays, and improved quality of life 3, 4, 5
When Open Approach May Be Considered
- In resource-limited settings where laparoscopic equipment or expertise is unavailable 3
- When conversion from laparoscopic to open approach is necessary 3
- In facilities where modern anesthetic equipment or trained anesthetists are not available, as the procedure can be performed under local anesthesia 2
Important Considerations
- Approximately 20% of appendectomies are considered difficult for various reasons, making adequate incision choice important for trainees 1
- The incision should provide sufficient access to handle unexpected findings or complications 1
- Regardless of incision type, surgery should be performed within 24 hours of admission for uncomplicated appendicitis, with earlier intervention (within 8 hours) for complicated cases 4, 5