STERNOTOMY has been used by a number of people, including Blalock1 and Clagett2 for thymectomy and Holman3 for pericardiectomy. As far as is known, however, Wangensteen4 is the first to have used it for upper abdominal surgery. Combined with a midline supraumbilical incision, Wangensteen states that it has come to be the incision of choice at the University of Minnesota Clinic in operations on the stomach, liver, diaphragm, and spleen. In the cases in which I have used it, it has afforded unusually good exposure with a very benign postoperative course.
A midline incision is made from the xiphoid to just above the umbilicus and the peritoneal cavity entered. Thorough exploration is performed, and it is determined whether the addition of sternotomy is necessary to perform the surgical procedure at hand. If so, a small incision is made in the tissues just beneath the xiphoid