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Rives-Stoppa Repair and Peritoneal Flap Hernioplasty
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
After the retro-muscular space on each side has been entered, it is developed laterally as far as the linea semilunaris predominantly by blunt dissection, but localised adhesions between the muscle and the sheath are common and are better divided with diathermy rather than risk tearing small muscle fibres. When using the diathermy, stay as close as possible to the firm, white sheath on the ‘floor’ to minimise bleeding: any vessels should be elevated with the muscle. The lateral extent of the retro-muscular space – the linea semilunaris – is confirmed by observation of the segmental neuro-vascular bundles entering the rectus abdominis muscle (Figure 8.3).
Abdomen
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The rectus muscles originate from the pubic crest, pubic symphysis and pubic tubercle and insert onto the costal cartilages of ribs 5 to 7 and the xiphoid process. They are separated by the linea alba in the midline and the linea semilunaris along their lateral border (Figure 3.8).
The Stomach (ST)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Immediately inferior to the costal arch, 6 cun above the umbilicus. Approximately 2 cun lateral to the anterior midline. In the rectus abdominis muscle, midway between its lateral border (linea semilunaris) and the linea alba. Level with CV 14 and KI 21.
Parastomal hernia after ileal conduit urinary diversion: re-visiting the predictors radiologically and according to patient-reported outcome measures
Published in Scandinavian Journal of Urology, 2020
Ahmed M. Harraz, Ahmed Elkarta, Mohamed H. Zahran, Amr A. Elsawy, Mohamed A. Elbaset, Ali Elsorougy, Yasser Osman, Ahmed Mosbah, Hassan Abol-Enein, Atallah A. Shaaban
None of our patients received neoadjuvant chemotherapy. We adopt a standard technique for fashioning an IC after radical cystectomy. A stoma therapist examines the patient to determine and marks the appropriate site of stoma prior to surgery. After radical cystectomy, 15 cm of the terminal ileum is isolated and restoration of intestinal continuity is obtained. The predetermined stoma site is incised and minimal subcutaneous fat is dissected till the rectus sheath is approached. A cruciate incision is then performed at the anterior rectus fascia and the rectus muscle is split and a similar cruciate incision is performed in the opposing posterior fascia and peritoneum. The aperture should admit at least the tips of two fingers. However, a wider or narrower opening might be required based on the surgeon's preference. The conduit is then passed through the opening and fixed to both the anterior rectus sheath and posterior fascia/peritoneum with 2-0 polyglactin sutures all around sparing the cranial part to avoid compression of the vascular mesentery. The stoma is then reflected upon itself using 3-0 poliglecaprone sutures. Ureters are then anastomosed to the proximal end of the IC in an end-to-side fashion. A 16 F Foley’s catheter is then fixed for 5 days in the IC and ureteral stents for one week. During the abdominal wall closure, the posterior rectus sheath was sutured till the level of linea semilunaris and then the lower parts of both rectus abdominis muscles are approximated. Patients are then discharged for scheduled visits for oncological and functional outcomes lifelong.
Gangrenous appendicitis contained within a Spigelian hernia
Published in Baylor University Medical Center Proceedings, 2021
Rohan Anand, Jasmin Rahesh, John Ciubuc, Karla Esparza-Leal, Abbie Schuster, Roy Jacob, Steven E. Brooks, Robyn Richmond, Catherine A. Ronaghan
The Spigelian aponeurosis was first described by Flemish physician Adrian van der Spiegel (1578–1625), who also first characterized the linea semilunaris. Ninety percent of Spigelian hernias occur in the region of the “Spigelian hernia belt,”4,5 a transverse 6-cm wide zone below the arcuate line 6 cm below the umbilicus6,7 in the region of the posterior sheath of the rectus abdominus muscle.