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Anatomy of the Anterior Abdominal Wall
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Beneath the transversus abdominis lies the transversalis fascia which is closely adherent to the peritoneum beneath. Recent cadaveric studies suggest that this fascia is actually composed of two lamellae that can be separated; this is of direct relevance to the surgeon performing a transversus abdominis release from both above and below, as the natural planes of dissection from either direction are separated by the posterior lamella of the transversalis fascia.1
Hernias
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Types of inguinal hernia➢ Can be direct or indirect according to their surgically defined relationship to the inferior epigastric artery.Indirect hernias are in the inguinal canal, descending to the scrotum.■ Leave the abdomen via the deep inguinal ring to follow an oblique course through the inguinal canal.■ The peritoneal sac may represent a patent or reopened processus vaginalis.■ May extend to the tunica vaginalis surrounding the testis.➢ Direct hernias protrude anteriorly through transversalis fascia (Hasselbach’s triangle).➢ Pantaloon hernia describes a combination of both.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
C: Internal oblique and transversus abdominisRoof of the inguinal canal is composed of the arching fibres of internal oblique and transversus abdominis.Anterior wall of the inguinal canal is composed of external oblique and internal oblique (for the lateral 1/3).Posterior wall of the inguinal canalis is composed of transversalis fascia and conjoint tendon.Floor of the inguinal canal is composed of the inguinal canal.
EFEMP1 in Direct Inguinal Hernia: correlation with TIMP3 and Regulation Toward Elastin Homoeostasis as Well as Fibroblast Mobility
Published in Journal of Investigative Surgery, 2022
Xiaohui Peng, Zhongwu Guo, Yinlong Zhang, Baichen Sun, Qi Zhang
This study enrolled 20 direct IH patients who underwent IH repair and additional 20 patients with varicocele (served as controls) in our hospitals [8, 10]. For IH patients, a piece of 0.5 cm x 0.5 cm transversalis fascia was collected during the operation of repair. For controls, a piece of 0.5 cm x 0.5 cm transversalis fascia was collected from the edge of abdominal incisions during the varicocele operations using laparoscopic Palomo technique, which was performed with open technique through the inguinal canal. Transversalis fascia tissue was fixed with 10% formaldehyde (Sigma, USA) and blocked with paraffin immediately after collection. Informed consent was obtained from each patient before participating in this study, and the study was conducted according to the World Medical Association Declaration of Helsinki. The study was approved by the Ethics Committee of our hospital.
Intraoperative Neuromonitoring and Lumbar Spinal Instrumentation: Indications and Utility
Published in The Neurodiagnostic Journal, 2021
Ryan C. Hofler, Richard G. Fessler
Lateral lumbar interbody fusion (LLIF) can be a suitable approach to most of the lumbar spine, with satisfactory access from T12 to L5. The L5/S1 disc space is typically not accessible through this method. In this approach, a lateral retroperitoneal transpsoas corridor is utilized to access the lateral vertebral bodies and disc spaces (Mobbs et al. 2015; Xu et al. 2018). With the patient positioned in the lateral decubitus position, an incision is made over the posterior third of the disc space. The obliques and transversus abdominis are dissected bluntly to access the transversalis fascia, which is punctured to access the retroperitoneal space. Blunt dissection is utilized to mobilize the peritoneum off the psoas muscle. Under fluoroscopic guidance, a dilator is placed through the body of the psoas muscle over the disc space of interest. Continuous t-EMG is utilized to reduce the incidence of injury to the femoral nerve and lumbar plexus. If t-EMG thresholds indicate a safe distance from neural structures, sequential dilation can be performed to form the working corridor through the psoas muscle.
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
A uniform IAP is applied to the transversalis fascia that covers the internal surface of the abdominal wall. Numerical analyses are performed by applying a IAP in the range of 0 ÷ 13.3 kPa (0 ÷ 100 mmHg), which includes most of physiological values corresponding to common daily tasks (Cobb et al. 2005). In this range, two IAP levels, corresponding to 2.23 kPa (16.7 mmHg) in the sitting position and 10.8 kPa (81 mmHg) as during cough (Cobb et al. 2005), are selected to show numerical results and later recalled as P1 and P2, respectively. Analyses are performed simulating a pure passive condition, obtained only by applying the internal pressure, and the active state in which the internal pressure is simultaneously applied to the muscular contraction. To compare the mechanical response of the abdominal wall in the two cases, the same loading law is assumed with the pressure characterized by a nonlinear function. The loading law is arbitrary chosen to enable the comparison even if it does not correspond to the physiologic increasing of IAP with muscular contraction.