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Case 2.15
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
The procedure starts with the patient supine. I prefer to raise the VRAM prior to the laparotomy – to minimize operating in a potentially contaminated field.I will raise the rectus muscle with a skin paddle based on the predicted skin requirement and the supraumbilical anterior rectus sheath – whilst preserving the posterior and infraumbilical rectus sheathes.The deep inferior epigastric vessels are visualized and followed to the external iliac vessels.I will then transect the rectus insertion off the pubis using cutting diathermy but ensuring that I preserve the pyramidal component to take the tension off the vessels.Once the abdominal resection is complete, I will place the flap in a bag, then rotate the flap 180 degrees to pass it into the pelvis, and thenincise the peritoneum where the vessels enter it to prevent the vein from kinking along the edge of this.I will then close the rectus sheath with a double PDS suture and an onlay mesh to further decrease the risk of an abdominal weakness.
General Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Direct inguinal hernias enter the inguinal canal through a weakness or defect in its posterior wall more medially and as a result emerge medially to the inferior epigastric vessels within Hesselbach's triangle.
Future perspectives in peritoneal malignancy
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
Ioanna Panagiotopoulou, Alexios Tzivanakis, Tom Cecil
There however remained the challenge of abdominal wall fistulating disease around stomas and through surgical scars. This was addressed by Henk Giele, plastic surgeon at Oxford University Hospitals, who proposed where necessary the donor abdominal wall could be transplanted with microvascular anastomosis onto the inferior epigastric vessels (Figure 15.5).
Incidental finding of a congenital unilateral absence of the vas deferens during robotic inguinal hernia repair: missing a crucial landmark. A case report
Published in Acta Chirurgica Belgica, 2023
Kim Pauwaert, Filip Muysoms, Maxime Dewulf
A bilateral robotic-assisted TAPP inguinal hernia repair was planned. During surgery, a lateral hernia (L2) on the right side, and a medial hernia (M2) left side were observed [5]. However, standard intraoperative dissection of the MPO did not allow for an identification of the VD on the left side, whereas a clear VD was observed on the right side. There was no suspicion of an intraoperative lesion or ligation of the VD. Gonadal and inferior epigastric vessels were present on both sides. An intraoperative image illustrating the CUAVD is added as Figure 1. Intra-operative clinical evaluation of the scrotum showed normal testes on both sides, with a palpable VD on the right side. No VD was palpable in the scrotum on the left side. The procedure was continued with placement of one large Parietex Progrip mesh (Medtronic, USA) (13 × 28 cm) in the preperitoneal space covering both groins.
Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy
Published in Journal of Obstetrics and Gynaecology, 2022
Satit Klangsin, Nantaka Ngaojaruwong, Hatern Tintara
In the operating room, after the primary trocar penetrated at the infra-umbilical level, CO2 was insufflated at 15 mmHg. Before the ancillary trocar penetration, video recordings were made using 0-degree (26046AA Laparoscope Hopkins II, 0-degree Telescope 5 mm × 29 cm, KARL STORZ, Tuttlingen, Germany) and 30-degree (26046BA Laparoscope Hopkins II, 30-degree Telescope 5 mm × 29 cm, KARL STORZ, Tuttlingen, Germany) laparoscopes by an expert surgeon who did not assess the recordings at a later time. For each patient, the recordings were continuously taken from the insertion at the left round ligament of the abdominal wall (5–8 cm above the pubic symphysis) (Perrone et al. 2005; Deffieux et al. 2011) to the insertion at the right side in order to obtain direct visualisation of the three landmarks: (i) the inferior epigastric vessel, (ii) the edge of the rectus abdominis muscle and (iii) the upper border of the bladder dome. After completion of the video recordings, ancillary port insertion was performed, and the patient underwent surgery as planned.
Indocyanine Green Angiography for Continuously Monitoring Blood Flow Changes and Predicting Perfusion of Deep Inferior Epigastric Perforator Flap in Rats
Published in Journal of Investigative Surgery, 2021
The superior abdominal wall artery, which enters rectus abdominis from the xiphoid side, is the dominant vessel in rats. It branches perforating arteries on both sides of the abdominal skin along the belly, connecting with the inferior epigastric vessels above the pubis [18]. In contrast, the inferior abdominal wall artery, which is the dominant vessel in humans, is connected with the superior abdominal wall artery beneath the xiphoid. To simulate the model of the human body, the blood supply design in rats should be contrary to that of humans. In the model of Hallock et al., superior abdominal wall artery was designed as the supply artery for DIEP flap in rat, while the inferior abdominal wall artery was designed as the supply artery for transverse rectus abdominis myocutaneous (TRAM) flap in the rat [18]. Drawing on these studies, we designed the above-presented model.