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Lateral Hernias
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The alternate technique develops the plane for the mesh between external and internal oblique muscles laterally, and continues into the ipsilateral retrorectus space medially. It is easiest to develop each plane separately and then join them to each other across the linea semilunaris as a final step, using diathermy to incise the tough, fibrous fusion of layers. Dissection becomes difficult over the costal margin superiorly and is limited by the inguinal canal inferiorly and so this approach is not ideal for the largest hernias. Once the mesh plane is established, the hernia defect through the underlying transversus abdominis and internal oblique muscles is closed with slowly absorbable sutures and the synthetic mesh is secured in place, with the external oblique closed to finally cover the mesh.21
Thoracofemoral bypass graft for aortoiliac occlusive disease
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
The patient is transferred to the operating table with a vacuum beanbag extending from the shoulders to the proximal thigh. After induction of general anesthesia and placement of a double-lumen endotracheal tube, the patient’s left hemithorax is elevated to an angle of 45-65 degrees with the table, while maintaining the pelvis as flat as possible; this facilitates the thoracotomy while allowing adequate exposure for the groin dissection. The left arm is supported in an arm cradle, helping to extend the lower thorax and avoid a brachial plexus injury. A roll is positioned under the right axilla and the air is evacuated from the beanbag. Pillow rests are placed under the knees and between the legs to prevent hyperextension; the patient’s legs are secured to the table with a safety strap. Should a full thoracotomy become necessary, a generous operative field should be fully prepared, making sure to include the left scapula and thoracic spine (Figure47.1).the left, extending parallel to the inguinal ligament and approximately 2 cm cephalad to its caudal border. The internal oblique muscles are divided bluntly in the direction of their fibers, and the transverse abdominal muscle and transverse fascia are opened in the lateral aspect of the incision (Figure47.2). The retroperitoneal space is then
Hernia and hydrocele
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
An epigastric hernia is a hernia through the midline linea alba. They present as a small mass, usually with incarcerated properitoneal fat, between the umbilicus and xiphoid process. They have no communication with the peritoneal cavity and do not resolve and hence should be repaired. An epigastric hernia should not be confused with a divarication of recti, which is a generalised weakness in the linea alba from the umbilicus to the xiphoid and virtually always resolves by 10 years of age. A spigelian hernia occurs through a defect at the intersection of the linea semicircularis, and the lateral border of the rectus abdominis muscle. These hernias are more frequent in girls and more commonly occur on the right side below the umbilicus. Pain in that area and fullness or an actual mass are the most common symptoms. These are difficult to detect and diagnose, and an ultrasonography or computed tomography may be needed. Repair is usually done with a tension-free closure through a transverse incision over the defect. Lumbar hernias are usually visible shortly after birth as a bulge (properitoneal fat) in the area bordered by the twelfth rib, sacrospinalis muscle and internal oblique muscle. These hernias tend to develop at the site of penetration of the intercostal nerves and vessels or of the ilioinguinal, iliohypogastric and lumbar nerves. Although they are asymptomatic, repair is advisable because the defect never resolves spontaneously and incarceration is possible. Repair may sometimes require a prosthetic mesh.
Modified Glasgow Prognostic Score, Prognostic Nutritional Index and ECOG Performance Score Predicts Survival Better than Sarcopenia, Cachexia and Some Inflammatory Indices in Metastatic Gastric Cancer
Published in Nutrition and Cancer, 2021
Bülent Demirelli, Nalan Akgül Babacan, Özlem Ercelep, Mehmet Akif Öztürk, Serap Kaya, Eda Tanrıkulu, Süleyman Khalil, Rahib Hasanov, Özkan Alan, Tuğba Akın Telli, Sinan Koca, Mustafa Erkin Arıbal, Beyza Kuzan, Faysal Dane, Perran Fulden Yumuk
A cross-sectional CT image of third lumbar vertebra (L3) at inferior aspect was selected for estimating muscle mass, as described previously, skeletal muscle areas (SMA) were separated within a Hounsfield units threshold range of -29 to 150 and tissue boundaries were manually outlined as needed by (14). SMA in the L3 region contains m. psoas, m. erector spinae, m. quadratus lumborum, m. transversus abdominis, external and internal oblique muscles, and m. rectus abdominis. To minimize measurement bias, one trained investigator, who was blinded for all anthropometric and surgical characteristics, identified and measured muscle area on a dedicated processing system (v2.8; INFINITT Healthcare, Seoul, Korea). Sarcopenia Index (SI) was calculated as L3 SMA (cm2)/height (m2). Due to a lack of studies from our country, the SI cutoff value was obtained by using both western (EGWSOP) and eastern (Harada Y, et al.) sources separately (15, 16). The mGPS, NLR, CIn, PI, PNI and ALI were constructed as described in Table 2. NLR cutoff value was accepted as the median value of patients’ NLR measurements.
The relationship between urinary incontinence, pelvic floor muscle strength and lower abdominal muscle activation among women with low back pain
Published in European Journal of Physiotherapy, 2019
Douglas Lima de Abreu, Pedro Teixeira Vidinha Rodrigues, Leticia Amaral Corrêa, Adriana de Carvalho Lacombe, Dianne Andreotti, Leandro Alberto Calazans Nogueira
In this study, the term lower abdominal muscle refers to the combined activation of both TrA and the internal obliques since it has been shown that the drawing-in manoeuvre does not activate the TrA in isolation but also the transverse fibres of the internal oblique muscles [26]. A pressure biofeedback unit (Stabilizer®) was used to assess lower abdominal muscle activation. The pressure bag, measuring 16.7 × 24cm, is made of non-elastic material and is accompanied by a pressure gauge (sphygmomanometer) that ranges from 20 mmHg to 100 mmHg, with 2 mmHg intervals on the scale [27]. The participants were positioned in prone on a rigid stretcher with feet off the surface and upper limbs along the trunk. The pressure biofeedback unit was placed under the abdomen so that the inferior border was just cranial to the anterior superior iliac spines. Changes in pressure readings were calculated from a baseline of 70 mmHg. A pressure reduction of ≥4 mmHg is considered a normal response [28]. The use of the pressure biofeedback unit has been shown to be reliable [29] for lower abdominal muscle assessment. The participants were instructed to perform an abdominal drawing-in manoeuvre, which has been shown to be a reliable and valid means to activate the lower abdominal muscle [26,30]. Participants were allowed to perform three practice repetitions and then were requested to perform the drawing-in manoeuvre for 10 seconds while breathing normally and avoiding changes in pelvic and spinal positions.
Minimally invasive repair of a lumbar hernia utilizing the subcutaneous space only
Published in Baylor University Medical Center Proceedings, 2019
Jessica S. Clothier, Marc A. Ward, Ahmed Ebrahim, Steven G. Leeds
Prior to the operation, the location of the patient’s hernia was marked. This allowed the specific location of the hernia to be identifiable once the patient was in the prone position. The patient underwent general endotracheal anesthesia and was placed in the prone position (Figure 1b). An incision was made in the skin approximately 8 to 10 cm superior to the marked lumbar area on the right side, and the subcutaneous tissue was bluntly dissected to the fascia overlying the ribs. Further blunt dissection was used to start the subcutaneous pocket, taking care not to make the skin incision too large. A trocar was placed into this incision and insufflation was started. The small pocket was visualized, and under direct visualization another trocar was placed through the skin and into the subcutaneous space. Ultrasonic shears were used to tunnel down to the fascia and follow it to the marked skin location of the hernia, facilitating the enlargement of the subcutaneous pocket. A third trocar was placed. The subcutaneous pocket extended over the lumbar hernia area down to the iliac crest and posterior midline (Figure 1c). The hernia sac was identified and opened to expose its contents and the defect in the fascia. The hernia sac was excised and a 1 polydioxanone barbed suture was used to close the defect primarily in layers. The fascia surrounding the internal oblique muscle was approximated first and reinforced with a sublay mesh. A medium-weight, low-density polypropylene mesh was cut to fit the defect and laid on top of the approximated fascia. Next, the fascia surrounding the external oblique muscle was closed with the same suture encasing the mesh (Figure 1d).