Modern Views on Surgical Anatomy of the Inguinal Canal at the Inguinal Hernias

10.12737/5913 ◽  
2014 ◽  
Vol 21 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Любых ◽  
E. Lyubykh ◽  
Черных ◽  
A. Chernykh ◽  
Закурдаев ◽  
...  
Keyword(s):  
Inguinal Canal ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Surgical Anatomy ◽  
Abdominal Muscles ◽  
Anatomical Structures ◽  
Anatomical Dissection ◽  
Results Of Treatment ◽  
Inguinal Hernias ◽  
Internal Oblique

The purpose of this work is to study surgical anatomy in the patients with inguinal hernias of various kinds. Material. This work is performed on 41 corpses with inguinal hernias. Topographic and anatomical dissection of the inguinal canal with measurement of the linear parameters of anatomical structures, histological examination of specimens of the internal oblique abdominal muscles, the transverse fascia of the abdomen were carried out. Results. The authors have studied the structure of the posterior wall of the inguinal canal in the patients with oblique, direct, supravesical and inguinal-scrotal hernias. At persons with direct and supravesical inguinal hernias, a deformation is observed, mainly, in the medial inguinal fossa and supravesical fossa, showing great value inguinal gap, bland crescent aponeurosis, thinning of the transverse fascia of the abdomen. Increase of deep inguinal rings is observed in persons with oblique inguinal hernias. Dystrophy of abdominal muscles has always with inguinal hernias, and it is pronounced in the patients with inguinal-scrotal hernias. Conclusions. At surgical treatment of patients with direct inguinal hernias it is necessary to carry out correction of a posterior wall of the inguinal canal, in the patients with oblique inguinal hernias the anterior wall of the inguinal canal has to be surely restored. In the application of mesh materials in patients with large inguinal hernias, the results of treatment are doomed to fail, because the endoprosthesis only closes hernial wall that when failure of muscle function will clearly increase.

To the Question about the Peculiarities of the Structure of Transverse Abdominal Fascia at the Persons of Different Sex, Age and with Different Form of the Inguinal Period

10.12737/4990 ◽  
2014 ◽  
Vol 21 (2) ◽  
pp. 21-26
Author(s):  
Любых ◽  
E. Lyubykh ◽  
Малеев ◽  
Yu. Maleev ◽  
Черных ◽  
...  
Keyword(s):  
Inguinal Canal ◽  
Structural Features ◽  
Abdominal Muscles ◽  
Valve Mechanism ◽  
Back Wall ◽  
Inguinal Hernias ◽  
Abdominal Fascia ◽  
Boundary Location ◽  
Internal Oblique ◽  
Deep Inguinal Ring

The study was aimed at finding new structural features of the rear wall of the inguinal canal, the use of which allow to improving the prevention of inguinal hernias. The study involved 123 corpses of different sex and age. Anatomical and physiological nature of the valve mechanism inguinal canal, the peculiarities of the structure of the back wall in individuals of different sex and age were revealed; the various forms of inguinal gap were studied. Using cluster analysis of transverse fascia thickness abdominal length and height of the deep inguinal ring was one of three variants of the structure back wall of the inguinal canal: a strong, transient and weak. The technique of determining the location of the deep inguinal ring relative to the edge of the internal oblique abdominal muscles is offered. The use of this technique objectively reflects the anatomical and physiological characteristics of the inguinal canal as a whole. In interpreting the results of a valve mechanism of deep inguinal ring should be considered ineffective in the medial or medial edge of the boundary location of the deep inguinal ring relative to the internal oblique abdominal muscles. Functional and anatomical factors that contribute to the formation of inguinal hernias were identified. It is proved that the triangular shape of the inguinal gap causes a high risk of inguinal hernias. In both sexes the transverse abdominal fascia becomes thinner with age, and the deep inguinal ring increases in size. The obtained data will improve the effectiveness of preventive measures.

scholarly journals Immediate and late follow-up results of auto- and alloplastic operations in inguinal hernias

2020 ◽  
Vol 87 (11-12) ◽  
pp. 48-53
Author(s):  
Z. T. Shirinov ◽  
E. A. Alieva ◽  
Z. N. Azadova ◽  
N. Kh. Khankishiev
Keyword(s):  
Comparative Analysis ◽  
Posterior Wall ◽  
Late Results ◽  
Anterior Wall ◽  
Comparative Investigation ◽  
Morbidity Rate ◽  
Inguinal Hernias ◽  
Total Extraperitoneal ◽  
Significant Difference

Objective. To conduct a scientific investigation for comparative investigation of results of auto- and allohernioplastic operations. Materials and methods. The investigation was based on analysis of postoperative results in 400 patients, ageing 16 - 85 yrs old, to whom in Scientific Surgical Centre named after Acad. M. A. Topchibashev and the City of Shirvan Central Hospital in 2009-2019 yrs period surgical treatment for inguinal hernia was conducted. Depending on the procedure of hernioplasty applied, the patients were divided into two Groups. In a control one (n=200) the operations were performed, using open autohernioplasty only. In the main Group (n=200) open procedure and laparoscopic allohernioplasty, using different synthetic nets, were applied. Results. Comparative analysis of intraoperative, postoperative immediate and late follow-up results in the patients after auto- and allohernioplasty was done. In accordance to criteria of the intraoperative and immediate postoperative morbidity rate the statistically meaningful differences between two groups of patients were absent. Good late results of allohernioplasty were noted in (71.8 ± 3.41)%, satisfactory - in (17.2 ± 2.86)%, poor - in (11 ± 2.36)% patients (p<0.05); allohernioplasties - accordingly, in (80.2 ± 2.91)%, (16 ± 2.68)% and (3.8 ± 1.39)% patients (p<0.05). Comparative analysis done have shown the statistically much better results of allohernioplasty. Recurrences after allohernioplasty were observed in 3 times less frequently - 3.8%, and after autohernioplasty this index have constituted 11% (p < 0.05). Сomparative analysis of late follow-up results of various autohernioplastic methods have shown good results of Postemskyi method in (76.7 ± 7.72)% patients, and of Postempskyi method in our modification - in (88.9 ± 7.41)% patients. Good results of autoplasty in other methods were noted merely in equal quantity of the patients - in up to 70%, and statistically significant difference was absent. Conclusion. Basing on own results obtained, we recommend to perform autohernioplasty of the inguinal channel anterior wall in accordance to Girard-Sposokukotskyi method with Kimbarovskyi suture for oblique inguinal hernias, while in direct inguinal hernias, for strengthening of posterior wall, - Postempskyi method in our modification. In large and recurrent hernias in patients of middle and senile age it is expedient to apply a Lichtenstein plasty in our modification. Total extraperitoneal or transabdominal preperitoneal plasty is recommended if technical installments needed and the physician’n laparoscopic skills are available.

On the issue of radical inguinal hernia surgery

1936 ◽  
Vol 32 (7) ◽  
pp. 892-892
Author(s):  
B. Ivanov
Keyword(s):  
Inguinal Hernia ◽  
Spermatic Cord ◽  
Inguinal Canal ◽  
Oblique Muscle ◽  
Abdominal Muscles ◽  
Hernia Surgery ◽  
Internal Oblique Muscle ◽  
Hernial Sac ◽  
Inguinal Hernia Surgery ◽  
Internal Oblique

Stiasnу, H. K Describes his method of radical inguinal hernia surgery, which he recommended for cases where a simple Bassi operation is not applicable due to the weakness of the fascia and abdominal muscles, to strengthen the weakest parts of the inguinal canal the lower inguinal triangle and the site of the spermatic cord exit , the hernial sac, after its isolation from the latter, is cut off as high as possible, and the cord after the incision of the internal oblique muscle of the abdomen is pushed upward at an angle of 45-90 .

scholarly journals INTRAOPERATIVE ASSESSMENT OF TOPOGRAPHIC-ANATOMICAL PARAMETERS OF THE INGUINAL CANAL IN HERNIA AND ITS VALUE IN CHOOSING HERNIOPLASTY METHOD

2021 ◽  
Vol 19 (2) ◽  
pp. 182-186
Author(s):  
S. A. Zhuk ◽  
◽  
S. M. Smotrin ◽  
Keyword(s):  
Inguinal Canal ◽  
Age Groups ◽  
Pairwise Comparisons ◽  
Abdominal Muscles ◽  
Inguinal Hernioplasty ◽  
Surgical Interventions ◽  
Internal Oblique ◽  
Comparative Description ◽  
Anatomical Parameters ◽  
Deep Inguinal Ring

Purpose. To give a comparative description of the topographic and anatomical parameters of the inguinal canal in hernias and to evaluate its importance in choosing a method of hernioplasty. Material and methods. In 120 patients with types II, IIIa, IIIb inguinal hernias, the height of the inguinal space (h-IS), the total thickness of the internal oblique and transverse abdominal muscles forming the upper wall of the inguinal canal (TMT) and the diameter of the deep inguinal ring (DDIR) were measured intraoperatively. Results. Pairwise comparisons of the IS height revealed statistically significant differences in this parameter between hernias types II and IIIa, as well as between types II and IIIb (p = 0.0432) in all age groups. In the studied age groups, there were statistically significant differences in the diameter of the deep inguinal ring between patients with hernias types II and IIIa, as well as types II and IIIb (p <0.001). The TMT of the upper wall of the IC in all age groups did not depend on the type of inguinal hernia and was associated with the patient's age. Conclusion. Intraoperative morphometry is an objective method for assessing the topographic and anatomical parameters of the inguinal canal and should underlie the choice of the method of tension or tension-free inguinal hernioplasty during open surgical interventions.

scholarly journals A novel method for assessing valvular mechanism of deep inguinal ring considering the objective topographic anatomical criteria

2014 ◽  
Vol 95 (3) ◽  
pp. 460-464
Author(s):  
A V Chernyh ◽  
E N Lyubyh ◽  
V G Vitchinkin ◽  
E I Zakurdaev
Keyword(s):  
Inguinal Canal ◽  
Objective Assessment ◽  
Ring Expansion ◽  
Lateral Position ◽  
Abdominal Muscles ◽  
Integral Rate ◽  
Boundary Location ◽  
Ring Location ◽  
Internal Oblique ◽  
Deep Inguinal Ring

Aim. To develop a method to assess the valvular mechanism of deep inguinal ring based on objective topographic anatomical criteria. Methods. The research was performed on 123 native corpses of persons without pathology of the anterior abdominal wall. Morphometric examination of the inguinal canal was carried out. The shape of the inguinal gap was determined, inguinal gap and inguinal canal length was measured, as well as deep inguinal ring length and height and deep inguinal ring height. Oval fissured inguinal gap was revealed in 49 (39.8%) persons, intermediate oval - in 51 (41.5%), triangular - in 23 (18.7%). Results. The dependence of the length of the inguinal canal, inguinal gap length, deep inguinal ring size and its standing height on the inguinal gap shape was examined. The method for an objective assessment of the deep inguinal ring valvular mechanism was proposed. The method is based on determining the deep inguinal ring location in reference to the internal oblique abdominal muscles by estimating the integral rate of the inguinal canal length and the inguinal gap length and deep inguinal ring height. Three options for the deep inguinal ring location: upper lateral, lower medial and boundary location are described. Deep inguinal ring positions were determined by cluster analysis. In cases of upper lateral position, which was observed in 28 (22.8%) of cases, the valvular mechanism of deep inguinal ring was stable. In cases of deep inguinal ring lower medial position (41 cases, 33.3%), the opposite results were gained. In cases of deep inguinal ring boundary location (54 cases, 43.9%), the valvular mechanism is stable, but may become insolvent if destructive changes of the lateral abdominal muscles and deep inguinal ring expansion were present. Conclusion. An objective method of assessing the deep inguinal ring valvular mechanism, based on determining the deep inguinal ring location in reference to the oblique abdominal muscles was developed.

Changes in abdominal muscles architecture induced by different types of breathing

2021 ◽  
pp. 1-7
Author(s):  
Iria Da Cuña-Carrera ◽  
Alejandra Alonso-Calvete ◽  
Yoana González-González ◽  
Mercedes Soto-González
Keyword(s):  
Effect Size ◽  
Health Care Professionals ◽  
Rectus Abdominis ◽  
Transversus Abdominis ◽  
Abdominal Muscles ◽  
Healthy Population ◽  
Different Types ◽  
Architectural Characteristics ◽  
And Behavior ◽  
Internal Oblique

BACKGROUND: The underlying morphology and behavior of abdominal muscles during breathing are still lacking in knowledge in healthy population. OBJECTIVE: To analyze the effects of three different types of breathing on the architectural characteristics of abdominal muscles. METHODS: Ninety-eight healthy subjects were measured to assess the effects of breathing on the abdominal muscles, subjects performed three different types of breathing and the muscular thickness was measured with ultrasound imaging, analyzing also the differences between sexes. RESULTS: During the three different types of breathing and in comparison with the resting state, an increase of the thickness has been reported in the transversus abdominis (p< 0.001; effect size = 2.44, very large) and internal oblique (p< 0.001; effect size = 1.04, moderate) in both sexes, but with a higher increase in men. External oblique and rectus abdominis increased their thickness through breathing only while the lips were with pursed (p< 0.05) with trivial effect sizes and only differences between sexes were found in rectus abdominis. CONCLUSIONS: All breathings activated the deepest abdominal muscles, but the most superficial were only activated with lips pursed. Moreover, men appeared to activate more the deepest abdominal muscles but also the rectus abdominis. Findings in this study support the use of different types of breathing depending on the muscle to be activated or the sex, helping health care professionals to address their interventions on the abdominal muscles with a more focused approach.

Comparison among low intensity bridge exercises using suspension devices based on muscle activity and subjective difficulty

2021 ◽  
pp. 1-6
Author(s):  
Sang-Yeol Lee ◽  
Se-Yeon Park
Keyword(s):  
Inclination Angle ◽  
Muscle Activity ◽  
Erector Spinae ◽  
Trunk Muscles ◽  
Oblique Muscle ◽  
Abdominal Muscles ◽  
Internal Oblique Muscle ◽  
Low Intensity ◽  
Erector Spinae Muscle ◽  
Internal Oblique

BACKGROUND: Recent clinical studies have revealed the advantages of using suspension devices. Although the supine, lateral, and forward leaning bridge exercises are low-intensity exercises with suspension devices, there is a lack of studies directly comparing exercise progression by measuring muscular activity and subjective difficulty. OBJECTIVE: To identify how the variations in the bridge exercise affects trunk muscle activity, the present study investigated changes in neuromuscular activation during low-intensity bridge exercises. We furthermore explored whether the height of the suspension point affects muscle activation and subjective difficulty. METHODS: Nineteen asymptomatic male participants were included. Three bridge exercise positions, supine bridge (SB), lateral bridge (LB), forward leaning (FL), and two exercise angles (15 and 30 degrees) were administered, thereby comparing six bridge exercise conditions with suspension devices. Surface electromyography and subjective difficulty data were collected. RESULTS: The rectus abdominis activity was significantly higher with the LB and FL exercises compared with the SB exercise (p< 0.05). The erector spinae muscle activity was significantly higher with the SB and LB exercises, compared with the FL exercise (p< 0.05). The LB exercise significantly increased the internal oblique muscle activity, compared with other exercise variations (p< 0.05). The inclination angle of the exercise only affected the internal oblique muscle and subjective difficulty, which were significantly higher at 30 degrees compared with 15 degrees (p< 0.05). CONCLUSIONS: Relatively higher inclination angle was not effective in overall activation of the trunk muscles; however, different bridge-type exercises could selectively activate the trunk muscles. The LB and SB exercises could be good options for stimulating the internal oblique abdominis, and the erector spinae muscle, while the FL exercise could minimize the erector spinae activity and activate the abdominal muscles.

scholarly journals The role of local impedance drop in the acute lesion efficacy during pulmonary vein isolation performed with a new contact force sensing catheter—A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257050
Author(s):  
Nándor Szegedi ◽  
Zoltán Salló ◽  
Péter Perge ◽  
Katalin Piros ◽  
Vivien Klaudia Nagy ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Force Sensing ◽  
Lesion Formation ◽  
Force Time

Introduction Our pilot study aimed to evaluate the role of local impedance drop in lesion formation during pulmonary vein isolation with a novel contact force sensing ablation catheter that records local impedance as well and to find a local impedance cut-off value that predicts successful lesion formation. Materials and methods After completing point-by-point radiofrequency pulmonary vein isolation, the success of the applications was evaluated by pacing along the ablation line at 10 mA, 2 ms pulse width. Lesions were considered successful if loss of local capture was achieved. Results Out of 645 applications, 561 were successful and 84 were unsuccessful. Compared to the unsuccessful ablation points, the successful applications were shorter (p = 0.0429) and had a larger local impedance drop (p<0.0001). There was no difference between successful and unsuccessful applications in terms of mean contact force (p = 0.8571), force-time integral (p = 0.0699) and contact force range (p = 0.0519). The optimal cut-point for the local impedance drop indicating successful lesion formation was 21.80 Ohms on the anterior wall [AUC = 0.80 (0.75–0.86), p<0.0001], and 18.30 Ohms on the posterior wall [AUC = 0.77 (0.72–0.83), p<0.0001]. A local impedance drop larger than 21.80 Ohms on the anterior wall and 18.30 Ohms on the posterior wall was associated with an increased probability of effective lesion creation [OR = 11.21, 95%CI 4.22–29.81, p<0.0001; and OR = 7.91, 95%CI 3.77–16.57, p<0.0001, respectively]. Conclusion The measurement of the local impedance may predict optimal lesion formation. A local impedance drop > 21.80 Ohms on the anterior wall and > 18.30 Ohms on the posterior wall significantly increases the probability of creating a successful lesion.

scholarly journals Spade-Shaped Anastomosis after Laparoscopic Proximal Gastrectomy Using Double Suture Anchoring between the Posterior Wall of the Esophagus and the Anterior Wall of the Stomach (SPADE Operation): A Case Series

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 379
Author(s):  
Sin Hye Park ◽  
Harbi Khalayleh ◽  
Sung Gon Kim ◽  
Sang Soo Eom ◽  
Fahed Merei ◽  
...  
Keyword(s):  
Los Angeles ◽  
Anastomotic Stricture ◽  
Bile Reflux ◽  
Proximal Gastrectomy ◽  
Case Series ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Reflux Symptoms ◽  
Laparoscopic Proximal Gastrectomy ◽  
Technical Modifications

We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June 2017 and March 2020 were retrospectively reviewed. Reflux was evaluated based on the patients’ symptoms and follow-up endoscopy using Los Angeles (LA) classification and RGB Classification (Residue, Gastritis, Bile). Other complications were classified using the Clavien–Dindo method. The incidence of reflux esophagitis was 2.9% (1/34). Bile reflux was observed in six patients (17.6%), and residual food was observed in 16 patients (47.1%) in the endoscopy. Twenty-eight patients had no reflux symptoms (82.4%), while five patients (14.7%) and one patient (2.9%) had mild and moderate reflux symptoms, respectively. The rates of anastomotic stricture and ileus were 14.7% (5/34) and 11.8% (4/34), respectively. No anastomotic leakage was observed. The incidence of major complications (Clavien-Dindo grade III or higher) was 14.7%. The SPADE operation following laparoscopic PG is effective in reducing gastroesophageal reflux. Its clinical usefulness should be validated using prospective clinical trials.

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