Posterior Rectus Sheath: A Prospective Study of Laparoscopic Live Surgical Anatomy during Total Extraperitoneal Preperitoneal Hernioplasty

Background: Of all hernias encountered, incisional hernias can be the most frustrating and difficult to treat. The aim of this study is to find out the incidence of incisional hernia at different sites and to find out their possible causes.Methods: This was a prospective study of 50 cases of Incisional hernias admitted during the period between July 2017 to July 2019. Collected data is analysed over a period of 3 months. Patients with Incisional hernia satisfying the inclusion criteria, attending surgery OPD at Dr. D. Y. Patil Medical College, Pimpri, Pune were included in study group.Results: Mean age at presentation was 45 (32/50) were female 18 patients were male. Majority of the patients were obese. Infra-umbilical variety of incisional hernia is most common 42%. The most common primary surgery is tubal ligation was 14 (28%). Significant association noted between diabetes mellitus and SSI, p value <0.05. There is a significant association between addictions (tobacco, smoking and alcohol) and hernias in umbilical region and above p value <0.005.Conclusions: The incidence of incisional hernia is more in multiparous females. Infra-umbilical midline was the most common site for herniation in 42% of cases. Lower midline incisions are more prone for herniation as the posterior rectus sheath is deficient below arcuate line. The most common previous surgery was tubectomy 14. Diabetes and SSI played important role in causing incisional hernia in our study.

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Posterior rectus sheath variations: surgical significance and clinical implications for laparoscopic hernia surgeons

International Surgery Journal ◽

10.18203/2349-2902.isj20180375 ◽

2018 ◽

Vol 5 (2) ◽

pp. 683 ◽

Cited By ~ 1

Author(s):

Maulana M. Ansari

Keyword(s):

Anatomic Variation ◽

Research Work ◽

Rectus Sheath ◽

Operation Time ◽

Surgical Anatomy ◽

College Hospital ◽

Medical College ◽

Posterior Rectus Sheath ◽

Surgical Emphysema ◽

Jawaharlal Nehru

Background: Laparoscopic hernia surgeon needs accurate knowledge of not only of target inguinal region but also of adjacent access areas, but he/she is severely constrained by absence of research work on laparoscopic live surgical anatomy in literature.Methods: Prospective study in patients who underwent laparoscopic total extra-peritoneal preperitoneal (TEPP) inguinal hernioplasty through 3-midline-port technique at Jawaharlal Nehru Medical College Hospital, Aligarh between 2010 and 2015.Results: Sixty-eight TEPP repairs were performed in 60 adult patients. Overall incidence of conversion to Open/TAPP hernioplasty was 4% of all cases, but conversion secondary to the anatomic variation of short PRS was seen in only 1.4% of all cases. The endvision and ease of procedure (EOP) were 8.20±1.33 and 7.27±2.05 visual analog score respectively, and both of them were adversely affected in presence of variant PRS anatomy. Average operation time (OT) for unilateral TEPP hernioplasty was 1.9 hours and it was adversely affected in presence of variant PRS anatomy. Overall incidence of surgical emphysema was 16%, and its development was significantly more in presence of variant PRS anatomy. Overall incidence of peritoneal injury, postoperative seroma, infection and chronic pain was 28%, 10%, 6.7% and 1.5% respectively, but they were not affected by variant PRS anatomy.Conclusions: Posterior Rectus Sheath Variations had significant impact on the intra-operative working but did not affect post-operative clinical outcome. Keen observation, timely recognition of anatomic variations and judicious dissection are essential keys for smooth conduct of the well-organized TEPP hernioplasty with ease, safety, rapidity and better results.

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Rectus Sheath Block (RSB) Analgesia Could Enhance Significantly the Patient Satisfaction Following Midline Laparotomy in Benign Disease and in Cancer: A Prospective Study With Special Reference to Nitrosative Stress Marker Nitrotyrosine (NT) Plasma Concentrations

Anticancer Research ◽

10.21873/anticanres.13252 ◽

2019 ◽

Vol 39 (3) ◽

pp. 1383-1389

Author(s):

VIIVI KUOSMANEN ◽

IINA SAIMANEN ◽

DINA RAHKOLA ◽

JARI KÄRKKÄINEN ◽

TUOMAS SELANDER ◽

...

Keyword(s):

Patient Satisfaction ◽

Prospective Study ◽

Special Reference ◽

Nitrosative Stress ◽

Plasma Concentrations ◽

Rectus Sheath ◽

Benign Disease ◽

Midline Laparotomy ◽

Rectus Sheath Block ◽

A Prospective Study

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Intraoperative Observation during Total Extraperitoneal Repair (TEP)

The American Surgeon ◽

10.1177/000313482008600235 ◽

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.

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