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Abdominal surgery: General principles of access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Nigel J. Hall, Katherine A. Barsness
The skin is incised in the midline over a length and location appropriate for the incision. This may be entirely supraumbilical (e.g. gastrostomy, fundoplication) entirely infraumbilical, or above and below the umbilicus, either continuing vertically through the umbilicus or curving around one side of it. Having divided subcutaneous fat and fascia, the midline linea alba is encountered and incised over a short distance with a scalpel. Above the umbilicus, the falciform ligament is entered and incised to enter the peritoneal cavity. The edges of the incision are elevated and a plane is developed deep to the linea alba, which is then incised. Below the umbilicus, the recti muscles sit behind the strong fascial layers and can be split in the midline (Figure 27.8). Above the pubic bone care should be taken to avoid inadvertently entering the bladder, particularly in a small child.
Additional Pre-operative Considerations and Techniques
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Danette Wright, Charlotte Ralston, Dominic Slade
The abdominopelvic cavity is a semi-rigid space, and abdominal wall compliance is affected by the presence of an incisional hernia. In midline ventral hernias, disruption of the linea alba results in unopposed contraction of the lateral abdominal wall muscles; furthermore there are histological changes in these muscles which account for their increased stiffness and altered compliance.28 While the anterolateral abdominal muscles and diaphragm can undergo a degree of reshaping and stretching to accommodate increased intra-abdominal volume, this is not infinite.29 After hernia surgery, there is a decrease in total respiratory system compliance, which is predominantly due to a decreased chest wall compliance in turn leading to increased work of breathing and oxygen requirements.30 Sudden increases in intra-abdominal pressure, as can occur when reducing the contents of a large hernia, can overwhelm these compensatory mechanisms, resulting in intra-abdominal hypertension and respiratory failure.30
Abdomen
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
With the patient in the supine position, a linear probe is placed just above umbilicus in the transverse plane. The linea alba is identified in the midline with the two rectus muscles either side. Scanning laterally, the semilunaris is identified on the lateral border of the rectus with the external oblique, internal oblique and transversus abdominis muscle layers seen further laterally. After identifying the rectus muscles, the anterior and posterior portions of the rectus sheath and the peritoneum (a hyperechoic line beneath the posterior rectus sheath), an in-plane approach is used.
The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial
Published in Physiotherapy Theory and Practice, 2021
Nadia Keshwani, Sunita Mathur, Linda McLean
Physiotherapeutic interventions for DrA typically include exercise therapy and/or abdominal binders (Keeler et al., 2012). A wide range of abdominal exercises are prescribed (Keeler et al., 2012; Litos, 2014), with a pervasive focus on transversus abdominis muscle activation (Keeler et al., 2012). Such exercises have theoretical merit as the connective tissue sheaths surrounding the muscles of the lateral abdominal wall are continuous with the linea alba (Rizk, 1980). As such, activation of the muscles of the lateral abdominal wall, including the transversus abdominis, can mechanically load the linea alba (Lee and Hodges, 2016; Scott-Conner and Dawson, 2009). Mechanical loading may stimulate the formation and alignment of collagen (Buckwalter and Grodzinsky, 1997; Kjaer et al., 2009), thereby enhancing the capacity of the linea alba to transfer loads across the midline. Although this hypothesis remains unconfirmed, abdominal exercises performed in the post-partum period may improve the mechanical function of the linea alba.
The effects of the muscular contraction on the abdominal biomechanics: a numerical investigation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Piero G. Pavan, Silvia Todros, Paola Pachera, Silvia Pianigiani, Arturo N. Natali
Different tissues compose human abdominal wall. Linea alba, aponeuroses and fasciae are connective tissues that provide a purely passive action in protecting and supporting the abdominal cavity. Abdominal muscles, namely Rectus Abdominis (RA), External Oblique (EO), Internal Oblique (IO) and Transversus Abdominis (TA), contribute with their active behavior to the accomplishment of physiological tasks as breathing, coughing, phonation and postural control (Iizuka 2011). Each of these muscles is characterized by a specific fiber orientation. The RA consists in a pair of muscles symmetrically disposed with respect to linea alba, with fibers disposed along craniocaudal direction (Ahluwalia et al. 2004). The EO muscle is the most external and the largest of the three flat anterolateral muscles of the abdomen. It originates from the lower ribs posteriorly, to interdigitate with both the latissimus and the serratus muscles. The direction of the fibers is almost horizontal in the uppermost portion, while they become oblique in the lowest portions where they fold on themselves to form the inguinal ligament (Ahluwalia et al. 2004). The IO muscle originates from the anterior two-thirds of the iliac crest and lateral half of the inguinal ligament. It is characterized by a fiber direction almost perpendicular to the EO fibers. Finally, the TA muscle is the deepest of the abdominal muscles. TA originates from the 7th to 12th costal cartilages, the lateral third of the inguinal ligament and iliac crest, characterized by muscle fibers with horizontal orientation (Ahluwalia et al. 2004).
Left-handedness in cardiac surgery: who’s right?
Published in Acta Chirurgica Belgica, 2020
K. Cathenis, J. Fleerakkers, W. Willaert, P. Ballaux, D. Goossens, R. Hamerlijnck
The incision is initiated four centimeters below this reference point. The incision, performed with the right hand, is continued through the first marking and over the xyphoid. The linea alba is incised. Cautery is used for hemostasis of the subcutis, to divide the suprasternal ligament and mark the middle of the sternum. If the surgeon feels uncomfortable making the incision with the right hand, the procedure should be initiated on the left side of the patient using the left hand.