Abdominal surgery: General principles of access
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
The posterior rectus sheath is picked up with two pairs of artery forceps and a small incision is made between them, taking care not to damage the underlying bowel (Figure 27.4a). Once air has entered the peritoneal cavity, the bowel falls away, unless it is distended or there are adhesions, and the incision can be completed safely. In the neonate, the transversalis muscle is well developed and vascular and may be divided using diathermy. The incision can be extended laterally as much as is necessary for the procedure by lifting the abdominal wall muscles with artery forceps applied to the upper and lower edges of the posterior rectus sheath, and cutting the external oblique, internal oblique, and transversalis muscle layers with the diathermy, while protecting the underlying bowel (Figure 27.4b). Particular care should be taken to avoid damage to distended bowel, which should be protected while completing the incision. Additional care should also be taken in cases of previous abdominal surgery or previous abdominal sepsis as there may be adhesions. These may require careful dissection from the posterior aspect of the incision when a pre-existing incision is being reopened. If possible, it is advisable to begin the incision beyond the end of the scar so that the peritoneum is opened where it is “normal” and underlying adhesions are less likely to be present.
Negotiating and Coping with Complex Events of Practice and Difficult Conversations
A. O. Mahendran in Moments of Rupture: The Importance of Affect in Medical Education and Surgical Training, 2019
We were both scrutinizing the operating field. In this case it comprised a 35-year-old man’s lower abdomen, or groin (as commonly termed), and the contents of his spermatic cord (a rope-like structure that proceeds from the tissues of the lower abdomen to the testicles in the scrotum and carries the vas deferens, that is, a white tube that carries sperm). The scheduled operation was ‘surgical repair of an inguinal, or, groin hernia’. A hernia occurs due to a weakness in the abdominal wall, leading to the contents of the abdomen (such as bowel or fat) pushing through into the tissues of the groin. This typically presents as a protruding lump that is more prominent when standing, straining or coughing. However, 15 minutes into the operation, we were both stumped. We had identified the weakness in the wall and were trying to identify what exactly was herniating into the groin. What we found was a rather small, shrivelled, egg-like structure ensconced in the spermatic cord.
The Abdominal Muscles
Alan D. Miller, Armand L. Bianchi, Beverly P. Bishop in Neural Control of the Respiratory Muscles, 2019
The abdominal wall differentiates into a deep and superficial group of muscle layers. The deep group is comprised of the psoas magnus, the psoas parves, the illiacus, and the quadratus lumborum. The superficial group, the only group considered in this chapter, is a four-layered structure comprised of the external oblique abdominus (EO), the internal oblique abdominus (10), the rectus abdominus (RA), and the transverse abdominus (TA) muscles. The fibers in each layer assume a direction different from that in the other layers. Therefore, the mechanical action of an abdominal muscle contraction depends on both fiber direction and the concurrent activity of the other muscles. When acting in isolation the mechanical action of EO, in a supine anesthetized dog, always causes an expansion of the anterior-posterior and transverse diameters of the rib cage, whereas 10 and TA do not noticeably displace the rib cage when acting in isolation. After opening or eviscerating the abdomen, each of the four muscles deflate the rib cage and displace it caudally. The net effect of these two opposing actions on the rib cage depends upon the balance between the insertional force tending to deflate the rib cage and the rise in abdominal pressure and the passive distension of the relaxed diaphragm tending to expand the lower rib cage.26 The mechanical action of the abdominal wall is complex because the force it generates is applied to a load determined by viscous and nonlinear elastic resistances.66
Robotic versus hybrid assisted ventral hernia repair: a prospective one-year comparative study of clinical outcomes
Published in Acta Chirurgica Belgica, 2023
Pirjo Käkelä, Kirsi Mustonen, Tuomo Rantanen, Hannu Paajanen
Repair of abdominal wall hernia is one of the most commonly performed surgical procedures [1]. Ventral hernias can be categorized as spontaneous such as epigastric, umbilical or Spigelian or acquired hernias [2]. About 5% of the general population is born with or develops a primary hernia [3]. Incisional or secondary hernias develop in up to 30% of patients undergoing abdominal operations [4]. Hernia types according to location are categorized using the European Hernia Society classification [5]. Operations of ventral hernia are associated with numerous complications including pain, seroma, infection, eventration, recurrence, poor cosmesis or poor function of the abdominal wall [6]. Laparoscopic ventral hernia repair (LVHR) usually implies intraperitoneal placement of a prosthetic mesh without closure of the fascial defect. It is often technically difficult to close the fascial defect, particularly for hernias wider than 10 cm [7,8]. In some cases, the mesh bulges through the defect and produces a sensation of hernia recurrence. Primary closure of the defect (hybrid) performed in a minimally invasive fashion is good for recreation of the abdominal wall, and to prevent recurrence or bulging [8].
Physiotherapeutic assessment and management of overactive bladder syndrome: a case report
Published in Physiotherapy Theory and Practice, 2023
Bartlomiej Burzynski, Tomasz Jurys, Karolina Kwiatkowska, Katarzyna Cempa, Andrzej Paradysz
Manual therapy of the lumbopelvic hip complex consisted of trigger point therapy, friction massage (i.e. stroking, rubbing, and kneading), and manual diaphragm release. These techniques were performed with the patient lying on her back with the upper limbs placed along the back and the lower limbs placed on a couch. The purpose was to relax the abdominal wall. Manual therapy per vaginum used trigger point therapy, friction massage (i.e. stroking, rubbing, and kneading), and post-isometric relaxation. This manual therapy was performed in the supine position with the patient’s lower limbs bent at the hip and knee joints with the feet placed flat on the couch. The purpose was to relax the pelvic floor muscles. Therapy of the superficial back line myofascial meridian and the lateral line myofascial meridian consisted of post-isometric relaxation and mobilization techniques. The techniques were performed in a supine position with the lower limb raised, bent at the hip joint, and straight at the knee joint. In order to stretch the posterior tape, a dorsiflexion of the foot was performed; in order to stretch the lateral line myofascial meridian, the patient’s lower limb was placed in adduction. Additionally, the range of flexion in the hip joint was increased. Also, transverse massage of the muscles of the lower extremities as well as post-isometric relaxation of the muscles of the lower extremities was used to increase the effectiveness of therapy. Musculus piriformis therapy was carried out using trigger point therapy and friction massage. The techniques were performed in the front lying position.
Rehabilitation of a patient with bilateral rectus abdominis full thickness tear sustained in recreational strength training: a case report
Published in Physiotherapy Theory and Practice, 2022
Omer B. Gozubuyuk, Ceylan Koksal, Esin N. Tasdemir
The rectus abdominis muscle’s primary function is flexing the spine in the sagittal plane and increasing abdominal-pelvic pressure (Maquirriain, Ghisi, and Kokalj, 2007). The origin and insertion of the muscle are the anterior midline of the ribcage and pelvis, respectively. Therefore, pain originated from the myofascial unit of rectus abdominis can refer to a wide area. Physiological, anatomical and biomechanical characteristics of the abdominal wall muscles enable the classification of these muscles as the stabilizers and the movers (Norris, 2001). The movers consist of RA and external oblique (EO), and the stabilizers consist of internal oblique (IO) and transversus abdominis (TA). The traditional ‘crunch’ movement involves a person lying supine initially and elevating their scapula and head from the floor. This moment is performed mainly by the prime-mover RA muscle, as shown by electromyography (EMG) studies (Nordin and Frankel, 2001). Trunk is flexed with a concentric action and returned back to initial position with an eccentric action of the RA (Maquirriain, Ghisi, and Kokalj, 2007). Alternatively, the movement can be performed using a crunch machine, in sitting position (Figure 1).
Related Knowledge Centers
- Fascia
- Peritoneum
- Abdominal Cavity
- Skin
- Extraperitoneal Fascia
- Transversalis Fascia
- Transverse Abdominal Muscle
- Abdominal Internal Oblique Muscle
- Abdominal External Oblique Muscle
- Body