Intraoperative Observation during Total Extraperitoneal Repair (TEP)

2020 ◽  
Vol 86 (2) ◽  
pp. 146-151
Author(s):  
Lisheng Wu ◽  
Junsheng Li ◽  
Ran Miao
Keyword(s):  
Umbilical Artery ◽  
Vas Deferens ◽  
Rectus Sheath ◽  
Anatomical Variations ◽  
Preperitoneal Space ◽  
Anatomical Landmarks ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Posterior Rectus Sheath ◽  
Total Extraperitoneal

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4–10 cm). D2: 4.9 ± 0.8 cm (3.5–7 cm). D3: 6.8 ± 0.9 cm (5–9 cm). D4: 6.1 ± 1 cm (4.8–8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.

scholarly journals P037 TOTALLY ENDOSCOPIC SUBLAY REPAIR FOR DIASTASIS RECTI AND CONCOMITANT MIDLINE HERNIA: FIRST CASE VIDEO-REPORT

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Camillo Leonardo Bertoglio ◽  
Lorenzo Morini ◽  
Simona Grimaldi ◽  
Pietro Carnevali ◽  
Giovanni Ferrari
Keyword(s):  
Polyvinylidene Fluoride ◽  
Rectus Sheath ◽  
Barbed Suture ◽  
Preperitoneal Space ◽  
Anterior Rectus Sheath ◽  
Linea Alba ◽  
First Case ◽  
Diastasis Recti ◽  
Posterior Rectus Sheath ◽  
Sublay Repair

Abstract Aim We describe in detail the step by step technique of the first case of TES repair at our institution. Methods We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation. Results The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue. Conclusion Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure

scholarly journals The anatomy of superficial inferior epigastric artery flap

2008 ◽  
Vol 23 (5) ◽  
pp. 429-434 ◽  
Author(s):  
Mahdi Fathi ◽  
Ebrahim Hatamipour ◽  
Hamid Reza Fathi ◽  
Ali Abbasi
Keyword(s):  
Common Femoral Artery ◽  
Anatomical Variations ◽  
Inguinal Ligament ◽  
Common Trunk ◽  
Inferior Epigastric Artery ◽  
Hemifacial Atrophy ◽  
Flap Transfer ◽  
Epigastric Artery ◽  
Siea Flap ◽  
Muscle Sparing

PURPOSE: To describe the anatomical variations of superficial inferior epigastric artery (SIEA) flap as a muscle-sparing flap. METHODS: A series of 40 dissections were performed on 20 preserved or fresh male cadavers. The site origin and drainage of vessels, caliber, length, and correlation between diameter and length of pedicle were identified. RESULTS: The SIEA and SIEV were identified at inguinal ligament level in 38 (95%) and 40 (100%) dissections, respectively. The SIEA originated directly from a common femoral artery 22 (57.9%) or a common trunk with other arteries. The SIEA was found within 1 cm of the midpoint of the inguinal ligament in 33 of 38 cases. The meanSD length of SIEA was 3.041.73 (0.5-7) cm. The meanSD caliber of SIEA was 1.450.35 (0.7-2.1) mm. The length of SIEV ranged from 2.2 to 12 cm with a meanSD of 5.452.08 cm. The caliber of SIEV ranged from 1.6 to 4 mm with a meanSD of 2.140.45 mm. The length of SIEA correlated with caliber of arterial pedicle (p<0.001 and correlation coefficient = 0.517). CONCLUSION: The inferior epigastric artery flap can be applied to microsurgical flap transfer, potentially in breast reconstruction, hemifacial atrophy, phalloplasty, or when extremely large amounts of skin coverage are required.

scholarly journals Picture Quiz (Answer)

2005 ◽  
Vol 4 (2) ◽  
pp. 75-75
Author(s):  
U Nandy ◽  
◽  
GI Varughese ◽  
N Iqbal ◽  
TJ Constable ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Rectus Sheath ◽  
Low Molecular Weight ◽  
Rectus Abdominis Muscle ◽  
Inferior Epigastric Artery ◽  
Low Molecular Weight Heparins ◽  
Epigastric Artery ◽  
Hospitalised Patients ◽  
Coronary Syndromes ◽  
Rectus Sheath Hematoma

Subcutaneous low molecular weight heparins are widely used in hospitalised patients for the treatment of DVT, pulmonary embolism and acute coronary syndromes, as well as for thromboprophylaxis. Rectus sheath hematoma is a recognised, but sometimes misdiagnosed, complication of treatment with anticoagulant therapy,1 including full and prophylactic doses of low molecular weight heparin.2 Studies have shown that the most frequent location of a haematoma is in the lower part of the abdomen. The explanation for this lies in the anatomy of the abdominal wall.3 The rectus abdominis muscle lies between the aponeuroses of the transverse and oblique muscles, which form the so-called rectus sheath. In this lower aspect of the muscle the perforating branches of the inferior epigastric artery running in the preperitoneal fat may rupture causing a large haematoma widely spreading in this loose space. Care should be taken to avoid this area for injection of heparin, particularly in thin patients where inadvertent intramuscular.

scholarly journals Surgical Management of Left Upper Quadrant Sided Rectus Sheath Hematoma Occurred by Coughing in a Hemodialysis Patient

2015 ◽  
Vol 100 (1) ◽  
pp. 190-192 ◽  
Author(s):  
Sangchul Yun ◽  
Sungwoo Cho ◽  
Zisun Kim ◽  
Han Ul Chong ◽  
Jae Joon Kim
Keyword(s):  
Surgical Management ◽  
Surgical Approach ◽  
Conservative Management ◽  
Hemodialysis Patient ◽  
Rectus Sheath ◽  
Rectus Abdominis Muscle ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Field Of Vision ◽  
Rectus Sheath Hematoma

Abstract Rectus sheath hematoma (RSH) is a rarely-occurring disease that is usually associated with anticoagulation, trauma, or spontaneous events. Most spontaneous rectus sheath hematomas may be relieved with conservative management. However, some extreme situations need surgical approach. Respecting the fact that the inferior epigastric artery mainly supplies the rectus abdominis muscle, interrupting its proximal side would cease the bleeding. We present a stepped procedure of ligation of the inferior epigastric artery and evacuation of hematoma with good field of vision in case of rectus sheath hematoma in hemodialysis patient.

scholarly journals Spontaneous rectus sheath hematoma diagnosed by point-of-care ultrasonography

CJEM ◽  
2013 ◽  
Vol 15 (02) ◽  
pp. 120-123 ◽  
Author(s):  
Hamid Shokoohi ◽  
Keith Boniface ◽  
M. Reza Taheri ◽  
Ali Pourmand
Keyword(s):  
Emergency Department ◽  
Acute Abdomen ◽  
Point Of Care ◽  
Rectus Sheath ◽  
Inferior Epigastric Artery ◽  
Artery Pseudoaneurysm ◽  
Epigastric Artery ◽  
Emergency Department Patients ◽  
Point Of Care Ultrasonography ◽  
Rectus Sheath Hematoma

ABSTRACTSpontaneous rectus sheath hematoma is an uncommon condition that can mimic other conditions associated with an acute abdomen. We report the case of a patient with a spontaneous rectus sheath hematoma due to a ruptured inferior epigastric artery pseudoaneurysm who presented with hypotension and severe abdominal pain and was diagnosed using emergency department point-of-care ultrasonography. Point-of-care ultrasonography has been increasingly used in the evaluation of emergency department patients with acute abdomen and hypotension to expedite the diagnosis and management of aortic aneurysm and intraperitoneal bleeding. Resuscitation and urgent surgical and interventional radiology consultations resulted in the successful embolization of a branch of the inferior epigastric artery and a good outcome.

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