What is the meaning of Pfannenstiel?: A Comprehensive Guide

September 22, 2025 •

4 min read

The Pfannenstiel incision was first described over a century ago by German gynecologist Hermann Johannes Pfannenstiel. This technique explains what is the meaning of Pfannenstiel, an extremely common surgical procedure often associated with C-sections and other pelvic procedures.

Quick Summary

Pfannenstiel refers to a specific horizontal surgical incision made in the lower abdomen, most often utilized for procedures like C-sections and hysterectomies. It is highly valued for its excellent cosmetic outcome and lower risk of incisional hernia compared to traditional vertical incisions.

Key Points

What is the meaning of Pfannenstiel?: A Pfannenstiel is a horizontal surgical incision made in the lower abdomen, most famously for cesarean sections.
Cosmetic 'Bikini Cut': It is also known as the "bikini cut" because the scar is low and often hidden by pubic hair.
Versatile Application: The incision is used for various pelvic surgeries, including hysterectomies and some hernia repairs.
Minimally Invasive Muscles: The technique involves separating the abdominal muscles rather than cutting them, leading to less pain and faster healing.
Strong and Secure Closure: The method provides a durable abdominal wall closure, significantly reducing the risk of incisional hernias.
Limited Surgical Field: Its main limitation is that it provides limited access and visibility to the upper abdominal cavity.

The History Behind the Name

While the name "Pfannenstiel" might sound complex, its origin is quite straightforward. The term is derived from the German gynecologist Hermann Johannes Pfannenstiel, who first described this technique in 1900. He developed the incision with the dual purpose of providing excellent surgical access to the pelvic organs while also prioritizing a better cosmetic outcome for the patient. In English-speaking countries, it is sometimes also referred to as the Kerr incision, named after Monroe Kerr who popularized the method in the UK in 1911.

What Is a Pfannenstiel Incision?

The Pfannenstiel incision is a type of surgical access to the abdomen. The surgeon makes a transverse (horizontal) or slightly curved cut in the lower abdomen, positioned just above the pubic symphysis, typically within the pubic hairline. This is why it is colloquially known as the "bikini incision" or "bikini cut."

The Surgical Technique in Detail

The procedure for a Pfannenstiel incision is methodical and involves several layers of tissue:

Skin and Subcutaneous Fat: A transverse incision is made through the skin and fatty tissue.
Rectus Fascia: The anterior sheath of the rectus abdominis muscle is cut transversely.
Muscle Separation: Unlike other incisions where the muscles might be cut, the rectus abdominis muscles are separated vertically in the midline and retracted to the sides. This minimizes muscle damage and potential injury.
Peritoneum: The peritoneum, the membrane lining the abdominal cavity, is then entered with a vertical incision.

This method allows the surgeon to access the pelvic organs while minimizing trauma to the abdominal muscles, leading to a stronger wound closure and better healing. The transverse skin incision is aligned with the natural skin tension lines, which results in a thinner, less noticeable scar.

Key Medical Applications and Uses

The Pfannenstiel incision is versatile and is the go-to choice for a variety of surgical procedures, particularly in gynecology and obstetrics. Some of the most common applications include:

Cesarean Sections: The most frequent use, allowing safe delivery of a baby through the lower uterus.
Hysterectomy: Surgical removal of the uterus.
Oophorectomy: Removal of one or both ovaries.
Uterine and Ovarian Procedures: Access for the removal of benign growths like fibroids or cysts.
Certain Urologic and Orthopedic Procedures: Used for some bladder surgeries and procedures involving pelvic fractures.

Pfannenstiel vs. Other Abdominal Incisions

To understand the benefits of a Pfannenstiel incision, it is helpful to compare it with other common abdominal incisions, such as the midline (vertical) incision.


Feature	Pfannenstiel Incision	Midline (Vertical) Incision
Cosmetic Result	Excellent; scar is often hidden by pubic hair.	Poor; scar is visible and more prone to stretching.
Access	Good for pelvic organs; limited for the upper abdomen.	Excellent for access to the entire abdominal cavity.
Incisional Hernia Risk	Lower due to strong fascial closure and muscle preservation.	Higher, especially with multiple surgeries.
Surgical Time	Requires slightly more time for muscle separation.	Quicker to make initially.
Post-operative Pain	Generally less, as abdominal muscles are not cut.	Can be more painful, affecting breathing and mobility.
Wound Dehiscence Risk	Very low.	Higher risk of the wound opening up.

Advantages and Disadvantages

Choosing the right incision is crucial for patient outcomes. The decision often weighs cosmetic concerns against surgical needs.

Advantages

Superior Cosmetic Outcome: The low horizontal scar is aesthetically pleasing and is easily concealed by clothing or pubic hair regrowth.
Lower Risk of Hernia: The method of separating, rather than cutting, the rectus muscles results in a more stable abdominal wall and a reduced risk of incisional hernias.
Stronger Wound Closure: The transverse fascial incision and midline muscle separation create a robust closure.
Reduced Postoperative Pain: Less muscle trauma often leads to less pain and a quicker recovery for the patient.

Disadvantages

Limited Exposure: The incision restricts the surgeon's view to the lower abdomen, making it unsuitable for procedures requiring access to the upper abdomen or extensive exploration.
Slower Entry: The process of dissecting the skin and fat away from the fascia and separating the muscles can be slightly more time-consuming than making a vertical cut.
Risk to Blood Vessels: There is a risk of injury to the inferior epigastric vessels located near the rectus muscles during the procedure.

Post-Operative Considerations

Following a Pfannenstiel incision, patients can expect a smoother recovery compared to more invasive abdominal procedures. Pain management is typically straightforward, often requiring non-steroidal anti-inflammatory drugs. Patients are encouraged to ambulate soon after surgery to prevent complications like blood clots.

Wound Care: Keeping the incision site clean and dry is paramount to prevent infection. Patients should follow their doctor's instructions for dressing changes.
Activity Restrictions: Heavy lifting and strenuous activity are typically restricted for several weeks to allow for proper healing of the abdominal wall.
Scar Management: Over time, the scar will fade significantly. Massage and silicone products can help improve the appearance of the scar.

For more detailed information on surgical procedures and recovery, consult authoritative sources like the American College of Obstetricians and Gynecologists American College of Obstetricians and Gynecologists.

Conclusion

To understand what is the meaning of Pfannenstiel is to appreciate a surgical advancement that prioritizes both efficacy and patient well-being. This horizontal, low abdominal incision is a testament to the pursuit of better surgical outcomes, offering a secure, cosmetically favorable access point for a range of pelvic procedures. While it has limitations in terms of visibility compared to vertical incisions, its advantages in reduced pain, lower hernia risk, and aesthetic results have cemented its place as a standard technique in modern surgery.

Frequently Asked Questions

In simple terms, a Pfannenstiel is a horizontal surgical cut made just above the pubic bone. It is most commonly used for C-sections and is known for its good cosmetic result, as the resulting scar is low and can be concealed.

It is called a bikini incision or bikini cut because the transverse cut is made low enough on the abdomen that the scar is typically hidden by the pubic hairline or a bikini bottom.

The main benefit is a better cosmetic outcome and a lower risk of incisional hernia compared to traditional vertical abdominal incisions. The technique involves separating the abdominal muscles rather than cutting them, which results in a stronger and more stable closure.

Recovery is often considered to be less painful than a vertical incision because the abdominal muscles are separated instead of cut. However, full recovery still requires time and adherence to post-operative care instructions to ensure proper healing.

Yes, a key disadvantage is the limited surgical exposure it provides to the upper abdomen. This means it is not suitable for all types of abdominal surgery, especially those requiring a wider view or access to higher organs.

Yes, the type of external incision (Pfannenstiel vs. vertical) does not determine your eligibility for a VBAC (Vaginal Birth After Cesarean). What matters is the type of incision made on the uterus itself, which is almost always a low transverse uterine incision during a C-section.

Hermann Johannes Pfannenstiel was a German gynecologist who lived from 1862 to 1909. He is credited with developing and popularizing the surgical technique that bears his name in 1900.