Which incision is made lateral to the midline?

The paramedian rectus incision is designed to be lateral to the midline of the abdomen. This incision allows the surgeon to access the abdominal cavity while minimizing damage to the midline structures such as the linea alba. By placing the incision to the side of the midline, the surgeon can achieve better exposure to the underlying organs, which is particularly useful in procedures that require access to the lateral portions of the abdomen.

In contrast, the Whipple operation (pancreaticoduodenectomy) typically involves a midline incision or a combination of midline and transverse incisions to provide access to the pancreas, duodenum, and surrounding structures. Similarly, the Billroth II procedure, which involves a resection of the distal stomach and an anastomosis to the jejunum, is also performed through a median incision for optimal access. Vagotomy, which involves cutting the vagus nerve to reduce acid secretion, may utilize various incisions depending on the surgical approach, but a lateral incision is not standard for this procedure.

By understanding the characteristics and typical applications of the paramedian rectus incision, it becomes clear why it is the correct choice for an incision made lateral to the midline.