What is the most common incision? A comprehensive guide

September 24, 2025 •

4 min read

With more than 18 million surgical procedures performed in the US annually, the question of what is the most common incision is relevant to many patients. While there is no single universal answer, the most frequently performed incision depends heavily on the type of surgery, whether it is an emergency or planned procedure, and the advancement of surgical techniques.

Quick Summary

The most common incisions vary significantly depending on the surgical procedure, but the small port-site incisions used for minimally invasive (laparoscopic) surgery are now incredibly prevalent, while the midline incision is a traditional and common approach for emergency open abdominal surgeries.

Key Points

No Single 'Most Common' Incision: The most common incision varies depending on the type of surgery being performed, the urgency of the procedure, and modern surgical techniques.
Laparoscopic Incisions are Highly Common: Minimally invasive (laparoscopic) surgery uses several small port-site incisions, making this one of the most frequent surgical approaches for many common procedures.
Midline Incision for Open Surgery: For emergency or extensive abdominal open surgery, the vertical midline incision is a traditional and common choice due to its speed and wide access.
Pfannenstiel for C-sections: The low, transverse Pfannenstiel incision is very common for C-sections and other pelvic surgeries, favored for its cosmetic results.
Incision Choice Depends on Many Factors: A surgeon's decision is influenced by the surgical site, patient history, urgency, and cosmetic goals.
Faster Recovery for Minimally Invasive: Laparoscopic surgery generally leads to less pain, smaller scars, and a faster recovery compared to traditional open surgery.

Understanding the Landscape of Surgical Incisions

The choice of a surgical incision is a critical decision made by a surgeon, balancing the need for clear access to the surgical site with the desire to minimize patient trauma and promote faster recovery. This choice is not one-size-fits-all, as different procedures, patient conditions, and surgical innovations necessitate a variety of approaches. Moving from traditional open surgery to modern minimally invasive techniques has shifted the landscape, introducing new common practices.

The Shift to Minimally Invasive Surgery

For many routine procedures, such as gallbladder removal (cholecystectomy) and appendectomy, minimally invasive surgery has become the standard. This technique, also known as laparoscopic or 'keyhole' surgery, involves several small incisions rather than a single large one. The most common incision site for initial access in laparoscopy is often near the navel (umbilicus), where a small port is inserted to insufflate the abdomen with carbon dioxide and a camera (laparoscope) is introduced. Additional small incisions are then made for surgical instruments. These small, discreet port-site incisions are collectively one of the most common types of surgical access points used today due to their numerous benefits:

Significantly smaller scars
Reduced post-operative pain
Faster recovery and shorter hospital stays
Lower risk of infection

Common Traditional Open Incisions

Despite the rise of minimally invasive techniques, traditional open surgery is still required for many complex, extensive, or emergency procedures. In these cases, larger incisions are necessary to provide the surgeon with maximum visibility and access. Two of the most common examples include:

Midline Laparotomy: This vertical incision is made along the linea alba, a fibrous structure running down the midline of the abdomen. It is often considered the most common incision for emergency exploratory surgeries, including those for trauma, as it provides rapid and extensive access to the entire abdominal cavity. However, it is associated with a higher risk of incisional hernia compared to other abdominal incisions.
Pfannenstiel Incision: This transverse, slightly curved incision is made low on the abdomen, just above the pubic hairline. It is famously used for Cesarean sections and many gynecological and urological procedures. The incision's location results in a scar that is often well-concealed and provides good cosmetic results.

Other Specific and Common Incisions

Several other incisions are routinely used for specific procedures:

Lanz or Gridiron Incision: A small, transverse (Lanz) or oblique (Gridiron) incision made in the lower right quadrant of the abdomen, historically used for open appendectomies. The Lanz incision is cosmetically superior due to its alignment with the skin's natural tension lines.
Kocher Incision: An oblique incision below the right costal margin (rib cage), used to access the gallbladder and biliary tract during open cholecystectomy.
Median Sternotomy: A vertical incision that divides the sternum, providing wide access to the chest cavity. This is the most common incision for open-heart surgery.

Factors Influencing Incision Choice

Surgeons consider a range of factors when deciding on the best incision for a patient:

Type of surgery: Different organs require different access points. A liver transplant, for instance, requires a massive exposure, possibly a Chevron or Mercedes-Benz incision, while a routine gallbladder removal may only need small laparoscopic ports.
Urgency of the surgery: In an emergency, speed is paramount. A midline incision offers the fastest route to the abdominal cavity for diagnosis and trauma control.
Patient's history: Previous surgeries or existing scar tissue (adhesions) can dictate where new incisions are placed.
Patient's body habitus: A patient's weight and body shape can influence the feasibility and safety of certain incision types.
Cosmetic outcome: For elective procedures, minimizing scarring is often a priority, favoring techniques like laparoscopy or Pfannenstiel incisions.

Comparison of Open vs. Laparoscopic Incisions


Feature	Open Incision	Laparoscopic Incision
Incision Size	Single, large incision	Multiple, small (less than 1 cm) incisions
Access	Direct and wide view of internal organs	Indirect view via camera on a monitor
Surgical Trauma	Higher tissue disruption and muscle cutting	Less tissue disruption; muscle fibers often separated, not cut
Post-op Pain	Generally higher	Significantly lower
Hospital Stay	Longer	Often shorter, sometimes outpatient
Recovery Time	Slower return to normal activities	Faster return to normal activities
Infection Risk	Higher due to more exposed tissue	Lower
Hernia Risk	Potentially higher for certain types (e.g., midline)	Lower overall, but specific port-site hernias are possible

The Journey of Wound Healing

Regardless of the incision type, all surgical wounds follow a similar healing process, which consists of several overlapping phases:

Hemostasis: Within minutes to hours, the body works to stop bleeding by constricting blood vessels and forming a blood clot.
Inflammation: For the next few days, immune cells flock to the wound to clean out bacteria and debris, preparing the site for new tissue growth.
Proliferation: From about day 3 to 30, fibroblasts lay down a protein called collagen, which forms the new granulation tissue. This is the stage where the scar begins to form.
Remodeling (Maturation): This final phase can last from several months to over a year. The newly formed collagen is reorganized, making the scar tissue stronger and more flexible, though it never fully regains the strength of the original skin.

For more detailed information on surgical incisions and wound healing, the National Center for Biotechnology Information (NCBI) provides extensive resources, such as the StatPearls article on Surgical Access Incisions.

Conclusion

Ultimately, there is no single answer to what is the most common incision because the correct choice is tailored to the specific procedure and patient. While laparoscopic port-site incisions are now ubiquitous for many minimally invasive procedures, the traditional midline incision remains a vital tool for complex or emergency open surgeries. The best incision is always the one that provides the best outcome, balancing patient safety, recovery speed, and cosmetic considerations.

Frequently Asked Questions

The most common incision for a Cesarean section is the Pfannenstiel incision. This is a horizontal cut made across the lower abdomen, just above the pubic hairline. It is often referred to as a 'bikini cut' for its location.

While the midline incision is a traditional and very common choice for open abdominal surgery, especially in emergency situations, the rise of minimally invasive (laparoscopic) procedures means that multiple small port-site incisions are now more frequently used for many routine abdominal surgeries.

An open incision is typically a single, larger cut that allows a surgeon direct access to the surgical site. A laparoscopic procedure uses multiple, much smaller incisions (port sites) to insert a camera and instruments, offering a magnified view on a screen rather than direct visualization.

Not necessarily. The appearance of a scar depends on the type of incision, with smaller laparoscopic incisions generally leading to less noticeable scars. However, open incisions like the Pfannenstiel are also strategically placed for better cosmetic outcomes.

For an open appendectomy, a Lanz or Gridiron incision in the lower right abdomen was traditionally used. However, most appendectomies today are performed laparoscopically, requiring only a few small port-site incisions.

Surgical wound healing is a multi-stage process. Initial wound closure happens within weeks, but the remodeling and strengthening of the scar can take up to a year or longer. The timeline can be affected by factors like age, health conditions, and nutrition.

The surgeon's choice of incision depends on several factors, including the type of surgery, the location of the organ, the urgency of the procedure, any previous surgeries, and the desired cosmetic outcome. The best choice is always made to ensure patient safety and effective treatment.