Which incision is considered best for sigmoid surgery, apart from trauma cases?

The vertical paramedian incision is considered the best option for sigmoid surgery, apart from trauma cases, due to its potential advantages in exposing the sigmoid colon effectively while minimizing damage to the musculature and vascular structures of the abdominal wall. This incision provides sufficient access to the sigmoid area and allows for good visualization of the pelvic cavity, which is often critical during sigmoid procedures such as resections or diverticulitis management. The arrangement of the incision also enables better postoperative recovery as it tends to result in less pain and a lower incidence of complications related to wound healing.

In contrast, other types of incisions, while they may have their specific applications, do not offer the same level of access or protective benefits for sigmoid procedures. For instance, the vertical midline incision may provide broad exposure but can compromise the median line muscles and is typically less favored in elective cases due to increased postoperative discomfort. The oblique subcostal incision is primarily used for upper abdominal surgeries and doesn't lend itself well to sigmoid access. The lower transverse incision, while beneficial for certain lower abdominal surgeries, would not allow the necessary access to the sigmoid colon as effectively as the vertical paramedian incision does.