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General Surgery
Abdominal Wall and Hernias Incisions of the Abdominal Wall
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
11 sections · 156 slides
Overview
- Scope of this topic
Principles of abdominal incisions
- Physiology of the abdominal wall
- Requirements for a proper abdominal incision
- Planning the incision
- Naming and selection of incisions
- Reopening a previous incision
- Varieties of abdominal incisions
Vertical incisions
- Upper midline incision
- Closure of the upper midline incision
- Vertical incisions through the anterior abdominal wall
- Increased exposure by excision of the xiphoid process
- Lower midline incision
- Rectus (paramedian) incision
- Rectus sheath incision without muscle splitting
- Drains and wound dehiscence
- Pararectus incision (Kammerer-Battle)
- Midrectus (transrectus) incision
- Comparison of vertical incisions
- Vertical incisions compared by nerve and vessel injury
Transverse incisions
- Transverse incisions: general features
- Upper abdominal transverse incision
- Lower abdominal transverse incision
- Rockey-Davis incision
- Pfannenstiel incision: technique
- Iliohypogastric nerve in the Pfannenstiel incision
- Pfannenstiel incision: exposure and uses
- Modifications of the transverse incision
- Extensions of transverse incisions
- Courses of the iliohypogastric and ilioinguinal nerves
Oblique and inguinofemoral incisions
- Subcostal incision: technique
- Costal incision for biliary surgery
- Extensions of the oblique incision
- McBurney (gridiron) incision
- Extensions of the McBurney incision
- Right or left lateral oblique incision (Kocher)
- Incisions above the inguinal ligament
- Incisions below the inguinal ligament and other routes
Posterior and thoracoabdominal approaches
- Principles of lumbar incisions
- Posterior approaches to the kidney
- Oblique lumbar incision
- Pleural injury in the oblique kidney incision
- Vertical lumbar incision
- Layers divided in the vertical lumbar incision
- Structures encountered in the vertical approach to the kidney
- First muscle layer in the lumbar approach to the kidney
- Second muscle layer in the lumbar approach to the kidney
- Third layer in the lumbar approach to the kidney
- Thoracoabdominal incision: indications and criticism
- Left thoracoabdominal approach: course of the incision
- Thoracoabdominal incision crossing the costal margin
- Closure of the thoracoabdominal incision
Anatomic complications of abdominal incisions
- General complications of abdominal incisions
- Summary of Anatomic Complications of Abdominal Incisions
- Summary of Anatomic Complications of Abdominal Incisions (continued)
- Nerve injury and postoperative incisional pain
- Iliohypogastric nerve: course and injury
- Ilioinguinal nerve: course and injury
- Wound dehiscence: incidence and predisposing factors
- Suture technique and tissue quality in dehiscence
- Transverse versus midline incisions: comparative outcomes
- Timing of wound strength and of rupture
- Predisposing factors versus faulty closure
- Incisional hernia versus denervation bulging
- Principles of incisional hernia repair
- Major incisional hernia of the abdominal wall
- Consequences of an enlarging incisional hernia
- Objectives and techniques of incisional hernioplasty
- Choice and placement of prosthetic mesh
- Drainage and further repair techniques
- Laparoscopic repair of incisional hernia
- Suture material and recurrence after repair
- Complications of posterior lumbar incisions
Hernias of the anterior abdominal wall
- Epigastric (ventral) hernia
- Epigastric hernia in transverse section
- Congenital umbilical hernial defects
- Infantile umbilical hernia
- Acquired umbilical hernia in adults
- Umbilical hernia in section
- Paraumbilical nodule of Sister Mary Joseph
- Omphalocele (exomphalos)
- Sagittal section through a small omphalocele
- Omphalocele: operative hazards and outcome
- Gastroschisis
- Gastroschisis
- Contents and pathogenesis of gastroschisis
- Ileal prolapse at the umbilicus
- Lateral ventral (spigelian) hernia: the semilunar zone
- Sites of spigelian hernia and the semilunar zone
- Relation of a spigelian hernia to the inguinal structures
- Section through a spigelian hernia
- Spigelian hernia: rings, layers and repair
Inguinofemoral (groin) hernias
- Rings of the groin
- Indirect inguinal hernia: congenital and acquired types
- Course of the indirect inguinal hernia
- Defects of closure of the processus vaginalis
- Indirect sliding inguinal hernia
- Direct inguinal hernia
- Supravesical hernia
- External supravesical hernia in practice
- Three coexisting groin hernias in one patient
- Multiple groin hernias
- Four types of groin hernia and their landmarks
- Groin hernias defined by their route
- Interparietal hernia
- Interparietal hernia and the spaces it may enter
- Femoral hernia: anatomy and course
- Femoral hernia: differential diagnosis and paediatric cases
- Paediatric inguinal hernia: why it is not 'just a hernia'
- Timing and perioperative care in paediatric hernia
- Dissection of the sac in children
Laparoscopic herniorrhaphy and lumbar hernias
- Laparoscopic herniorrhaphy: the approaches
- Trocar placement and the large abdominal vessels
- Safe zones for trocar placement in the abdominal wall
- Anatomy of laparoscopic entry access
- Hernias of the posterior (lumbar) abdominal wall
- Complications of lumbar hernia repair
Anatomic complications of hernia repair
- Complications of anterior abdominal wall hernia repair
- Haemorrhage after groin hernia repair
- Femoral vein injury during groin repair
- Ischaemia and vessel ligation in the inguinal area
- Nerve injury in groin hernia repair
- Arterial supply of the testis and epididymis
- Arteries of the testis and epididymis
- Consequences of dividing the spermatic cord
- Epididymal branches and epididymectomy
- Venous drainage of the testis
- Mechanism of ischaemic orchitis and testicular atrophy
- Indirect hernial sac left in situ on the spermatic cord
- Injury to the ductus deferens and the cord
- Visceral injury and the strangulated hernia
- Relaxing incision of the rectus sheath
- Complications of femoral, interparietal and supravesical hernia repair
- Anatomic hazards near the internal ring in laparoscopic repair
- Reported laparoscopic complications by system
- Genital and urinary complications of laparoscopic repair
- Vessels at risk in the inguinofemoral region
- Nerves at risk in laparoscopic herniorrhaphy
- Variability of the groin nerves
- Gastrointestinal and other laparoscopic complications
- Reducing port-site herniation
- Key points: incisions
- Key points: hernias and their repair
- Sources cited in the text and figure legends
- Sources cited in the text and figure legends (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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