Pubic symphysis -anterior approach

* position – supine

* incision – 15cm curved incision in line with skin crease about 1 cm above pubic symphysis

* no internervous plane

* dissection
– deepen incision to ant. portion of rectus sheath
– ID & ligate superficial epigastric art. & vein
– divide rectus sheath transversely about 1cm above symphysis
– divide both rectus muscles 2-3mm above their insertion (likely torn)
– retract rectus sup. to reveal pubic symphysis
– push bladder gently off back of bone
– potential space = space of Retzius

* dangers
– bladder – gently push bladder off post. aspect of pubic symphysis

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