This document discusses the history and anatomy related to the preperitoneal approach for groin hernia repair. It notes that the preperitoneal space was first described in 1823 and contains fat, being bounded anteriorly by the transversalis fascia and posteriorly by the fascia iliaca. However, accumulated observations reveal the transversalis fascia has two layers, and the inferior epigastric vessels pass between rather than within this space. A true preperitoneal approach requires transecting the abdominal wall to provide exposure of the avascular preperitoneal space; unilateral posterior and anterior approaches do not adequately expose this space.
Laparoscopic anatomy of inguinal canalGergis Rabea
This document provides an in-depth overview of the anatomy of the inguinal region as viewed laparoscopically. It describes key anatomical landmarks such as Cooper's ligament, the umbilical artery, and epigastric vessels that define the spaces where direct and indirect inguinal hernias occur. Understanding the complex relationships between osseofascial, vascular, and visceral structures in the preperitoneal space is essential to avoid injury during laparoscopic hernia repair.
1) The patient presented with abdominal pain and vomiting and was found to have a hernia between the posterior rectus sheath and rectus muscle on the right side.
2) A CT scan confirmed a hernia with small bowel extending into the right rectus abdominis muscle.
3) In surgery, 65 cm of strangulated and necrotic small bowel was found within the hernia sac located between the posterior rectus sheath and rectus muscle. The small bowel was resected and the hernia was repaired.
1. Avascular necrosis of the talus is caused by interruption of blood supply to the bone, leading to cell death. It can result from trauma or non-traumatic causes like steroid use.
2. Diagnosis involves x-ray, CT scan, and MRI to identify signs of bone death. Conservative treatment involves rest while surgical options include core decompression, bone grafting, and fusions in more severe cases.
3. Treatment aims to relieve pain, prevent further bone damage, and restore joint function, starting with non-weightbearing and progressing to full weightbearing over several months depending on the procedure.
This document provides an overview of the anatomical structures of the anterior abdominal wall including landmarks, planes, quadrants, muscles, fascial layers, the inguinal canal, femoral canal, and relevant laparoscopic anatomy. Key structures discussed include the external oblique muscle, internal oblique muscle, transversus abdominis muscle, rectus abdominis muscle, rectus sheath, inguinal canal, femoral canal, spaces of Bogros and Retzius, and triangles/circles that are important for laparoscopy.
The anterior abdominal wall has several layers including skin, superficial fascia, muscles, and peritoneum. The superficial fascia contains two layers - Camper's fascia and Scarpa's fascia. There are 5 muscles in the anterior abdominal wall - 3 flat muscles (external oblique, internal oblique, transversus abdominis) and 2 vertical muscles (rectus abdominis, pyramidalis). The rectus abdominis muscles are enclosed in a sheath formed by the aponeuroses of the lateral muscles. Several important anatomical landmarks are described including the linea alba, arcuate line, and semilunar line. The abdominal wall has blood supply from superior and inferior epigastric
management of patients with end stage TMJ diseasesAditi Rajvanshi
This document discusses the management of patients with end stage temporomandibular joint (TMJ) disease. It covers various disease processes that can lead to end stage TMJ disease, the goals of reconstructive joint surgery, and different treatment modalities for TMJ reconstruction including autogenous grafts, alloplastic total joint replacement, distraction osteogenesis, and bioengineered tissues. Autogenous graft options discussed include costochondral grafts, sternoclavicular joints, calvarium, iliac crest, fibula, and metatarsal joints.
Anatomy of the anterior abdominal wall and incisionsGeorge Owusu
The document discusses the anatomy of the anterior abdominal wall and various incisions that can be made. It describes the embryology, layers, muscles and contents of the anterior abdominal wall. It also covers the principles of abdominal incisions and various types of incisions like midline, paramedian, transverse, and oblique incisions that can provide access to intra-abdominal organs and structures. Complications of abdominal incisions are also briefly mentioned.
The document provides an overview of pelvic anatomy including:
1) It describes the three compartments of the pelvis (anterior, middle, posterior), pelvic structures like the bladder, uterus and rectum, and three supporting structures (endopelvic fascia, pelvic diaphragm, urogenital diaphragm).
2) It explains the pelvic diaphragm muscles (levator ani, puborectalis), their roles in support and continence, and how they can be identified on MRI.
3) It discusses the endopelvic fascia and its role in supporting pelvic organs, as well as ligaments like the uterosacral lig
Laparoscopic anatomy of inguinal canalGergis Rabea
This document provides an in-depth overview of the anatomy of the inguinal region as viewed laparoscopically. It describes key anatomical landmarks such as Cooper's ligament, the umbilical artery, and epigastric vessels that define the spaces where direct and indirect inguinal hernias occur. Understanding the complex relationships between osseofascial, vascular, and visceral structures in the preperitoneal space is essential to avoid injury during laparoscopic hernia repair.
1) The patient presented with abdominal pain and vomiting and was found to have a hernia between the posterior rectus sheath and rectus muscle on the right side.
2) A CT scan confirmed a hernia with small bowel extending into the right rectus abdominis muscle.
3) In surgery, 65 cm of strangulated and necrotic small bowel was found within the hernia sac located between the posterior rectus sheath and rectus muscle. The small bowel was resected and the hernia was repaired.
1. Avascular necrosis of the talus is caused by interruption of blood supply to the bone, leading to cell death. It can result from trauma or non-traumatic causes like steroid use.
2. Diagnosis involves x-ray, CT scan, and MRI to identify signs of bone death. Conservative treatment involves rest while surgical options include core decompression, bone grafting, and fusions in more severe cases.
3. Treatment aims to relieve pain, prevent further bone damage, and restore joint function, starting with non-weightbearing and progressing to full weightbearing over several months depending on the procedure.
This document provides an overview of the anatomical structures of the anterior abdominal wall including landmarks, planes, quadrants, muscles, fascial layers, the inguinal canal, femoral canal, and relevant laparoscopic anatomy. Key structures discussed include the external oblique muscle, internal oblique muscle, transversus abdominis muscle, rectus abdominis muscle, rectus sheath, inguinal canal, femoral canal, spaces of Bogros and Retzius, and triangles/circles that are important for laparoscopy.
The anterior abdominal wall has several layers including skin, superficial fascia, muscles, and peritoneum. The superficial fascia contains two layers - Camper's fascia and Scarpa's fascia. There are 5 muscles in the anterior abdominal wall - 3 flat muscles (external oblique, internal oblique, transversus abdominis) and 2 vertical muscles (rectus abdominis, pyramidalis). The rectus abdominis muscles are enclosed in a sheath formed by the aponeuroses of the lateral muscles. Several important anatomical landmarks are described including the linea alba, arcuate line, and semilunar line. The abdominal wall has blood supply from superior and inferior epigastric
management of patients with end stage TMJ diseasesAditi Rajvanshi
This document discusses the management of patients with end stage temporomandibular joint (TMJ) disease. It covers various disease processes that can lead to end stage TMJ disease, the goals of reconstructive joint surgery, and different treatment modalities for TMJ reconstruction including autogenous grafts, alloplastic total joint replacement, distraction osteogenesis, and bioengineered tissues. Autogenous graft options discussed include costochondral grafts, sternoclavicular joints, calvarium, iliac crest, fibula, and metatarsal joints.
Anatomy of the anterior abdominal wall and incisionsGeorge Owusu
The document discusses the anatomy of the anterior abdominal wall and various incisions that can be made. It describes the embryology, layers, muscles and contents of the anterior abdominal wall. It also covers the principles of abdominal incisions and various types of incisions like midline, paramedian, transverse, and oblique incisions that can provide access to intra-abdominal organs and structures. Complications of abdominal incisions are also briefly mentioned.
The document provides an overview of pelvic anatomy including:
1) It describes the three compartments of the pelvis (anterior, middle, posterior), pelvic structures like the bladder, uterus and rectum, and three supporting structures (endopelvic fascia, pelvic diaphragm, urogenital diaphragm).
2) It explains the pelvic diaphragm muscles (levator ani, puborectalis), their roles in support and continence, and how they can be identified on MRI.
3) It discusses the endopelvic fascia and its role in supporting pelvic organs, as well as ligaments like the uterosacral lig
Presentation1, film readiing for barium studies.Abdellah Nazeer
This document contains radiological reports and images from barium studies showing various gastrointestinal conditions:
1. A lateral view shows a cricopharyngeus muscle throughout a swallow and a moderately large cricopharyngeal diverticulum exerting pressure on the esophagus.
2. Images show hypertrophic pyloric stenosis producing narrowing of the stomach antrum and duodenal bulb.
3. A barium esophagram demonstrates a type III hiatal hernia with organoaxial rotation.
4. Images show a microcolon with good barium evacuation in a delayed 24-hour film, presenting microcolon.
5. Images show abnormal rectosigmoid index
Laparoscopic repair of inguinal hernias Gergis Rabea
Since the introduction of laparoscopic cholecystectomy, surgeons have developed laparoscopic approaches to other commonly performed open abdominal and thoracic procedures
This document describes several surgical approaches for the tibia and fibula. It discusses anterior, medial, posterolateral, and posteromedial approaches for the tibia. It also covers anterolateral, medial, posteromedial, posterolateral, and Tschern-Johnson extensile approaches for the tibial plateau. Each approach is described in detail, including incision location, tissue dissection steps, indications, and potential dangers.
Surgical anatomy of anterior abdominal wall and inguinalपरमेश्वर श्रेष्ठ
This document provides a detailed anatomical summary of the anterior abdominal wall and inguinal canal. It describes the layers of the abdominal wall including skin, fascia, muscles and peritoneum. It outlines the boundaries, contents and coverings of the inguinal canal. Key structures passing through the canal include the spermatic cord in males and round ligament in females. Hernias are defined as protrusions through defects in surrounding walls, with indirect and direct inguinal hernias specified.
This document discusses the anatomy of the abdominal wall and cavity. It describes the major bony landmarks of the abdomen, including the iliac crest, anterior superior iliac spine, pubic crest, and inguinal ligament. It also outlines the three layers of muscles that make up the abdominal wall - the external oblique, internal oblique, and transverse abdominis. Additionally, it mentions that inguinal hernias occur when abdominal pressure finds weaknesses at the inguinal canal.
This document provides an overview of the anatomy of the anterior abdominal wall. It describes the embryogenesis and layers of the abdominal wall, including the external oblique, internal oblique, transversus abdominis, and rectus abdominis muscles. It also discusses the inguinal region and inguinal canal, noting the clinical significance of hernias occurring through weaknesses in these areas. Blood supply, lymphatics, innervation, and dermatomes of the anterior abdominal wall are also summarized.
3-D ultrasound is useful for evaluating shoulder pain. It allows visualization of the rotator cuff tendons, biceps tendon, and surrounding structures in multiple planes. Common applications include identifying tendinopathy, tears, calcifications, and other abnormalities. The multiplanar views and 3D reconstructions provide a more comprehensive assessment compared to standard ultrasound. Examples shown include tendinitis, partial and full-thickness tears, biceps tendon ruptures, and hematomas.
This document provides information about the anatomy of the anterior abdominal wall. It begins with an introductory case study about a new doctor struggling with surgical notes. It then covers the layers of the anterior abdominal wall, abdominal muscles and fascia, blood vessels and nerves, abdominal regions, hernias, and the inguinal canal. Diagrams are provided to illustrate key anatomical structures like the rectus sheath, abdominal wall incisions, and inguinal ring locations. The document aims to equip readers with knowledge of anterior abdominal wall anatomy.
Surgical Options In The Management Of Hernia Repairsafarmas
This document outlines surgical options for inguinal hernias. It discusses the definition and types of hernias, including inguinal and femoral hernias. For surgical management, it describes open hernia repair techniques like Bassini, Shouldice, and tension-free repairs using mesh, as well as laparoscopic approaches like TAPP and TEP. Complications are also outlined. The goal of hernia surgery is to reduce hernia contents and repair the defect using herniorrhaphy or hernioplasty techniques to minimize recurrence.
This document describes several surgical approaches to the hip and acetabulum. It discusses the Smith-Petersen anterior approach, which provides access to the anterior hip joint. It also covers the Watson-Jones anterolateral approach, most commonly used for total hip replacement. Additionally, it summarizes the Southern posterior approach, lateral approach, and medial (Ludloff's) approach. For the acetabulum, it outlines the ilioinquinal and posterior (Kocher-Langenbeck) approaches. Each approach is defined by its indications, patient positioning, incision, exposure, dangers, and relevant references.
This document discusses chest wall procedures, focusing on repair of pectus excavatum. It describes the Ravitch procedure for repair, which involves:
1) Resecting abnormal costal cartilages by developing the plane between cartilage and perichondrium and dividing the cartilage.
2) Performing a transverse anterior sternal osteotomy to allow anterior displacement of the sternum.
3) Implementing sternal fixation techniques to prevent posterior displacement after repair. Variations involve different fixation methods. The goal is to correct the deformity caused by abnormal cartilage growth.
The document discusses the layers of the abdominal wall including the skin, fascia, muscle layers like the external and internal oblique muscles and transverse abdominal muscle, and peritoneum. It also lists and describes various types of surgical incisions that can be made in the abdominal wall including Kocher subcostal, transverse muscle dividing, McBurney, oblique muscle cutting, Pfannenstiel, and posterolateral incisions. The document is authored by Dr. Abhishek Reddy and concludes with thanks.
The document describes the anatomy of the anterior abdominal wall, including its boundaries, layers, muscles and fascia. Key points include:
- It extends from the costal margins and xiphoid process superiorly to the iliac crests, pubis and pubic symphysis inferiorly.
- It is made up of skin, superficial fascia, deep fascia, muscles including the external oblique, internal oblique and transversus abdominis, as well as the rectus abdominis.
- Major landmarks include the xiphoid process, costal margins, iliac crests and inguinal ligament.
This document provides an anatomical overview of the anterior abdominal wall, including its layers, muscles, blood supply, innervation and clinical importance. It describes the boundaries and surface topography of the abdominal wall before detailing each layer, including the skin, superficial fascia, three flat muscles (external oblique, internal oblique, transversus abdominis), two vertical muscles (rectus abdominis, pyramidalis) and their attachments. It also discusses the rectus sheath, fascia transversalis, extraperitoneal fascia and peritoneum. The blood supply, venous and lymphatic drainage, dermatomes and innervation are summarized. Finally, it lists 10 examples of the clinical importance of the abdominal
This document provides an overview of the surgical anatomy of the anterior abdominal wall including key anatomical landmarks, planes, muscles, layers of the abdominal wall, the inguinal canal, femoral canal, and laparoscopic anatomy. It discusses 12 important anatomical landmarks of the anterior abdominal wall and identifies horizontal planes such as the xiphisternal plane and vertical planes including the midline and paramedian planes. The document also reviews the dermatomes, muscles and layers of the abdominal wall, structures within the spermatic cord and femoral canal, and relevant laparoscopic anatomy.
Normal Ankle and foot Radiographs by Dr AvinashAvinashDahatre
X ray ankle and foot radiographs are takent in day by day in radiological work up study done at Smbt medical college nashik. different radiographs are described with Hows its taken? and at what Kv given. refrence taken from YOCHUM Rowe book of radiology.
This document discusses the anatomy of the urogenital triangle and classification of urethral injuries. It begins with an overview of the bony pelvis and ligaments, followed by the muscles that support the pelvic floor including the levator ani and coccygeus. It then describes the urogenital diaphragm and its contents. Several classifications of urethral injuries are presented, including the McCallum & Col Pinto classification for posterior injuries and the AAST classification system for severity grading. Injuries can be anterior or posterior, with posterior injuries often associated with pelvic fractures from trauma.
1. The document discusses various incisions used for abdominal access during surgery.
2. It describes midline, paramedian, transverse, subcostal, McBurney's and Lanz incisions, noting the layers of tissue each passes through and advantages and disadvantages.
3. The ideal incision allows ease of access while minimizing damage to muscles, nerves and risk of infection post-surgery. Location and orientation of the incision depends on the target structures.
Presentation1, film readiing for barium studies.Abdellah Nazeer
This document contains radiological reports and images from barium studies showing various gastrointestinal conditions:
1. A lateral view shows a cricopharyngeus muscle throughout a swallow and a moderately large cricopharyngeal diverticulum exerting pressure on the esophagus.
2. Images show hypertrophic pyloric stenosis producing narrowing of the stomach antrum and duodenal bulb.
3. A barium esophagram demonstrates a type III hiatal hernia with organoaxial rotation.
4. Images show a microcolon with good barium evacuation in a delayed 24-hour film, presenting microcolon.
5. Images show abnormal rectosigmoid index
Laparoscopic repair of inguinal hernias Gergis Rabea
Since the introduction of laparoscopic cholecystectomy, surgeons have developed laparoscopic approaches to other commonly performed open abdominal and thoracic procedures
This document describes several surgical approaches for the tibia and fibula. It discusses anterior, medial, posterolateral, and posteromedial approaches for the tibia. It also covers anterolateral, medial, posteromedial, posterolateral, and Tschern-Johnson extensile approaches for the tibial plateau. Each approach is described in detail, including incision location, tissue dissection steps, indications, and potential dangers.
Surgical anatomy of anterior abdominal wall and inguinalपरमेश्वर श्रेष्ठ
This document provides a detailed anatomical summary of the anterior abdominal wall and inguinal canal. It describes the layers of the abdominal wall including skin, fascia, muscles and peritoneum. It outlines the boundaries, contents and coverings of the inguinal canal. Key structures passing through the canal include the spermatic cord in males and round ligament in females. Hernias are defined as protrusions through defects in surrounding walls, with indirect and direct inguinal hernias specified.
This document discusses the anatomy of the abdominal wall and cavity. It describes the major bony landmarks of the abdomen, including the iliac crest, anterior superior iliac spine, pubic crest, and inguinal ligament. It also outlines the three layers of muscles that make up the abdominal wall - the external oblique, internal oblique, and transverse abdominis. Additionally, it mentions that inguinal hernias occur when abdominal pressure finds weaknesses at the inguinal canal.
This document provides an overview of the anatomy of the anterior abdominal wall. It describes the embryogenesis and layers of the abdominal wall, including the external oblique, internal oblique, transversus abdominis, and rectus abdominis muscles. It also discusses the inguinal region and inguinal canal, noting the clinical significance of hernias occurring through weaknesses in these areas. Blood supply, lymphatics, innervation, and dermatomes of the anterior abdominal wall are also summarized.
3-D ultrasound is useful for evaluating shoulder pain. It allows visualization of the rotator cuff tendons, biceps tendon, and surrounding structures in multiple planes. Common applications include identifying tendinopathy, tears, calcifications, and other abnormalities. The multiplanar views and 3D reconstructions provide a more comprehensive assessment compared to standard ultrasound. Examples shown include tendinitis, partial and full-thickness tears, biceps tendon ruptures, and hematomas.
This document provides information about the anatomy of the anterior abdominal wall. It begins with an introductory case study about a new doctor struggling with surgical notes. It then covers the layers of the anterior abdominal wall, abdominal muscles and fascia, blood vessels and nerves, abdominal regions, hernias, and the inguinal canal. Diagrams are provided to illustrate key anatomical structures like the rectus sheath, abdominal wall incisions, and inguinal ring locations. The document aims to equip readers with knowledge of anterior abdominal wall anatomy.
Surgical Options In The Management Of Hernia Repairsafarmas
This document outlines surgical options for inguinal hernias. It discusses the definition and types of hernias, including inguinal and femoral hernias. For surgical management, it describes open hernia repair techniques like Bassini, Shouldice, and tension-free repairs using mesh, as well as laparoscopic approaches like TAPP and TEP. Complications are also outlined. The goal of hernia surgery is to reduce hernia contents and repair the defect using herniorrhaphy or hernioplasty techniques to minimize recurrence.
This document describes several surgical approaches to the hip and acetabulum. It discusses the Smith-Petersen anterior approach, which provides access to the anterior hip joint. It also covers the Watson-Jones anterolateral approach, most commonly used for total hip replacement. Additionally, it summarizes the Southern posterior approach, lateral approach, and medial (Ludloff's) approach. For the acetabulum, it outlines the ilioinquinal and posterior (Kocher-Langenbeck) approaches. Each approach is defined by its indications, patient positioning, incision, exposure, dangers, and relevant references.
This document discusses chest wall procedures, focusing on repair of pectus excavatum. It describes the Ravitch procedure for repair, which involves:
1) Resecting abnormal costal cartilages by developing the plane between cartilage and perichondrium and dividing the cartilage.
2) Performing a transverse anterior sternal osteotomy to allow anterior displacement of the sternum.
3) Implementing sternal fixation techniques to prevent posterior displacement after repair. Variations involve different fixation methods. The goal is to correct the deformity caused by abnormal cartilage growth.
The document discusses the layers of the abdominal wall including the skin, fascia, muscle layers like the external and internal oblique muscles and transverse abdominal muscle, and peritoneum. It also lists and describes various types of surgical incisions that can be made in the abdominal wall including Kocher subcostal, transverse muscle dividing, McBurney, oblique muscle cutting, Pfannenstiel, and posterolateral incisions. The document is authored by Dr. Abhishek Reddy and concludes with thanks.
The document describes the anatomy of the anterior abdominal wall, including its boundaries, layers, muscles and fascia. Key points include:
- It extends from the costal margins and xiphoid process superiorly to the iliac crests, pubis and pubic symphysis inferiorly.
- It is made up of skin, superficial fascia, deep fascia, muscles including the external oblique, internal oblique and transversus abdominis, as well as the rectus abdominis.
- Major landmarks include the xiphoid process, costal margins, iliac crests and inguinal ligament.
This document provides an anatomical overview of the anterior abdominal wall, including its layers, muscles, blood supply, innervation and clinical importance. It describes the boundaries and surface topography of the abdominal wall before detailing each layer, including the skin, superficial fascia, three flat muscles (external oblique, internal oblique, transversus abdominis), two vertical muscles (rectus abdominis, pyramidalis) and their attachments. It also discusses the rectus sheath, fascia transversalis, extraperitoneal fascia and peritoneum. The blood supply, venous and lymphatic drainage, dermatomes and innervation are summarized. Finally, it lists 10 examples of the clinical importance of the abdominal
This document provides an overview of the surgical anatomy of the anterior abdominal wall including key anatomical landmarks, planes, muscles, layers of the abdominal wall, the inguinal canal, femoral canal, and laparoscopic anatomy. It discusses 12 important anatomical landmarks of the anterior abdominal wall and identifies horizontal planes such as the xiphisternal plane and vertical planes including the midline and paramedian planes. The document also reviews the dermatomes, muscles and layers of the abdominal wall, structures within the spermatic cord and femoral canal, and relevant laparoscopic anatomy.
Normal Ankle and foot Radiographs by Dr AvinashAvinashDahatre
X ray ankle and foot radiographs are takent in day by day in radiological work up study done at Smbt medical college nashik. different radiographs are described with Hows its taken? and at what Kv given. refrence taken from YOCHUM Rowe book of radiology.
This document discusses the anatomy of the urogenital triangle and classification of urethral injuries. It begins with an overview of the bony pelvis and ligaments, followed by the muscles that support the pelvic floor including the levator ani and coccygeus. It then describes the urogenital diaphragm and its contents. Several classifications of urethral injuries are presented, including the McCallum & Col Pinto classification for posterior injuries and the AAST classification system for severity grading. Injuries can be anterior or posterior, with posterior injuries often associated with pelvic fractures from trauma.
1. The document discusses various incisions used for abdominal access during surgery.
2. It describes midline, paramedian, transverse, subcostal, McBurney's and Lanz incisions, noting the layers of tissue each passes through and advantages and disadvantages.
3. The ideal incision allows ease of access while minimizing damage to muscles, nerves and risk of infection post-surgery. Location and orientation of the incision depends on the target structures.
The document discusses features of the Kindle e-reader including its use of e ink display for easy reading, its ability to read various file formats like Mobi, ePub and PDF, and tools like Calibre and k2pdfopt that can manage Kindle files and convert formats. It also mentions using Kindle for reading news feeds and notes.
El documento describe el diseño geométrico del metro de Lima, Perú. Explica que el sistema está compuesto por 12 líneas que recorren la ciudad de forma circular, radial y lineal para conectar los distritos. Cada línea tiene un color asignado para facilitar la identificación por los pasajeros.
The Gerald Peters Gallery will open a new exhibit on July 8, 2011 from 5pm to 7pm. The exhibit will feature an illustrated price list of the works that will be on display. More information about the exhibit can be found at www.dcartpress.com.
El documento describe el diseño geométrico del metro de Lima, Perú. Repite la frase "DISEÑO GEOMETRICO DEL METRO DE LIMA" 11 veces, lo que indica que se centra en el diseño geométrico del sistema de transporte subterráneo de la ciudad de Lima.
Mexa conference sep 2010 final dg presentation publicpeteralanstephen
The document discusses the regulatory framework for maritime transport of dangerous goods. It outlines the role of the United Nations in developing recommendations through various committees and subcommittees. The UN recommendations, known as the Orange Book, provide a harmonized structure and provisions for classifying and transporting dangerous goods globally and are implemented by international organizations like IMO for maritime transport through codes like the IMDG Code.
The document discusses adding semantics to food labels using microdata to make the label information machine-readable. It provides an example of markup for a food label using HTML5 Microdata that identifies ingredients, product name, description and other details as individual properties. The benefits mentioned include allowing applications to understand the label information as well as enabling uses by supermarkets, restaurants and consumers on the web or via smartphones.
This document discusses planning and conducting market research in rural India. It covers objectives of rural research, data collection methods, sampling techniques, and challenges. Participatory Rural Appraisal is presented as an effective primary data collection method that empowers respondents. Considerations for instrument design, field procedures, and attributes of rural researchers are provided. Limitations of rural research and major players in the rural market research industry are also summarized.
This document discusses a research project analyzing the impact of foreign institutional investments (FIIs) on the Indian capital market from January 1993 to September 2001. The project uses correlation and regression analysis to study the relationship between monthly FII investments and seven Indian stock market indices, including the BSE Sensex and S&P CNX Nifty. The hypothesis is that the various indices rise with increases in FII investments. A literature review discusses several other studies examining relationships between stock markets and factors such as fund flows, seasonality, price pressure, and exchange rates.
Este documento describe un proyecto de aprendizaje para estudiantes de 5to grado en una escuela primaria en Venezuela. El proyecto se centra en los cambios que ocurren en el cuerpo durante la adolescencia y se llevará a cabo durante 45 días. El objetivo es fomentar el desarrollo armónico de los estudiantes a través de técnicas activas y contenidos relacionados con diferentes áreas de aprendizaje como lenguaje, matemáticas y ciencias naturales.
1. Laparoscopic views of inguinal anatomy differ from open surgery due to the posterior approach and two-dimensional view. Some structures are clearly visible with laparoscopy that require dissection during open surgery, and vice versa.
2. All groin hernias are believed to originate from a single weak area, the myopectineal orifice, which is divided into the inguinal and femoral defects by the inguinal ligament.
3. Five peritoneal folds on the internal abdominal wall form potential sites for hernia, including the lateral and medial inguinal fossae and supravesical fossa. The properitoneal space lies between the transversalis fascia and
The document summarizes the surgical anatomy of the inguinal canal. It describes the layers of the anterior abdominal wall and how they contribute to the structures of the groin. It details the internal and external oblique muscles and how their aponeuroses form the inguinal ligament, lacunar ligament and other structures. It explains the anatomy of the inguinal canal, including the superficial and deep inguinal rings, and contents of the spermatic cord in males that passes through the canal.
The rectum is the lower part of the large intestine extending from the sigmoid colon to the anal canal. It is around 5 inches long and located in the pelvis in front of the sacrum and coccyx. It has two flexures that follow the curves of the sacrum and coccyx. The upper third is covered in peritoneum while the lower third has no peritoneal covering. It is supplied by branches of the inferior mesenteric artery and drains into internal iliac and inferior mesenteric lymph nodes. A thorough understanding of rectal anatomy is important for surgical management of rectal conditions and cancer.
The rectum is the final 12 cm portion of the large intestine before the anal canal. It begins at the rectosigmoid junction and terminates at the anal canal. It has layers including mucosa, submucosa, inner circular muscle, outer longitudinal muscle, and serosa. The rectum receives blood supply from the inferior mesenteric artery and internal iliac arteries, and drains venously into the portal system. It has complex lymphatic drainage to both inferior mesenteric and internal iliac lymph nodes. The rectum and anal canal have both sympathetic and parasympathetic nerve innervation.
The document discusses the anatomy of the anterolateral abdominal wall. It describes the five muscles that make up the anterolateral wall - the external oblique, internal oblique, transversus abdominis, rectus abdominis, and pyramidalis. It details the structure, function and innervation of these muscles. The document also discusses the blood supply, lymphatic drainage and applied clinical considerations like different types of hernias related to weaknesses in the abdominal wall.
The document describes the anatomy of the abdominal wall. It notes that the abdomen is bounded superiorly by the diaphragm and inferiorly by the pelvis. The abdominal cavity contains most digestive organs and parts of the urogenital system. The abdominal wall has three layers of flat muscles - external oblique, internal oblique, and transverse abdominis - as well as two vertical muscles, rectus abdominis and pyramidalis. The flat muscles form aponeuroses that fuse to form the rectus sheath enclosing the rectus abdominis.
Laparoscopic Rectopexy (LRP) is a surgical technique used to treat persistent rectal prolapse in children. The authors present their experience using LRP at their hospital in Egypt. LRP involves mobilizing the rectum laparoscopically and attaching it to the sacrum using sutures or mesh to provide support. The document discusses the anatomy of the rectum and pelvic floor muscles. It also covers patient presentation, investigations, and surgical management options for rectal prolapse in both adults and children.
This document provides an overview of surgical incisions and abdominal wall anatomy relevant to urological surgery. It describes the layers of the abdominal wall including skin, fascia and muscles. It then classifies and describes various incision types for accessing the urinary system including flank, anterior abdominal, thoracoabdominal and midline incisions. Key abdominal wall muscles like the rectus abdominis and their innervation are also defined.
ANATOMY OF ESOPHAGUS-Dr.Neeraj Kumar Banoriadrnkb2000
1. The document describes the anatomy and development of the esophagus. It notes that the esophagus is divided into cervical, thoracic, and abdominal parts and discusses the layers of the esophageal wall.
2. Key details are provided on the myenteric plexus and development of the esophagus from the foregut. Figures show the positions of the esophagus relative to other structures in the neck and chest.
3. Anatomical features including constrictions, deviations, and tissues anchoring the esophagus are examined. The fascial planes surrounding the esophagus are also outlined.
This document provides information about hernias, including the anatomy of the abdominal wall and inguinal canal, definitions of hernia types, causes, pathophysiology, natural history, clinical presentation, diagnosis, and management. The main types of hernias are inguinal, femoral, and incisional. Hernias occur due to weaknesses in the abdominal wall that allow internal organs or tissues to protrude through. Clinical examination involves inspecting for lumps and evaluating their reducibility, contents, and impulse. Treatment options include conservative management with trusses or surgical repair/hernioplasty to reinforce weakened areas.
14 Abdominal Wall Anatomy and Inguinal Anatomy ppt.pptxmekuriatadesse
This document provides an overview of the anatomy of the abdominal wall and inguinal region. It begins with objectives and outlines, then discusses the layers and muscles of the anterolateral abdominal wall including the external oblique, internal oblique, transversus abdominis, rectus abdominis, and pyramidalis muscles. It also describes the fascia, neurovasculature, rectus sheath, linea alba, and inguinal region. The document concludes with a brief discussion of the inguinal canal.
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1. Hernia (2005) 9: 79–83
DOI 10.1007/s10029-004-0240-7
A PP L IE D AN A T OM Y
R. C. Read
The preperitoneal approach to the groin and the inferior
epigastric vessels
Received: 12 February 2004 / Accepted: 20 April 2004 / Published online: 5 June 2004
Ó Springer-Verlag 2004
Abstract Preperitoneal, a word coined by Nyhus in the terior, extraperitoneal, internal, or radical, which had
1960s, has been applied not only to posterior approaches been used previously. It denoted an approach based on
that he, Stoppa, and Wantz popularized but to anterior transection of the transversalis fascia and repair of groin
exposures of the groin, which divide the transversalis defects within a space next to the peritoneum. This plane
fascia. This assumes that all give similar views of the containing fat is where, it was supposed, the inferior
easily cleaved space of Bogros. However, accumulated epigastric vessels pass from their origin, the external iliac
anatomical observations reveal the transversalis fascia as artery and vein, to the rectus muscle.
having not one but two layers. The inferior epigastric
vessels run between rather than in the preperitoneal
space, which is avascular and has its own fascia lining History
the peritoneum. Historical evidence shows that both the
midline Cheatle-Henry and lateral Ugahary-Kugel Given the definition outlined above, the preperitoneal
approaches, which transect the abdominal wall, provide approach to the groin began in 1823 with Bogros [2]. He
excellent exposure of the avascular preperitoneal space. recommended dividing the roof and floor of the inguinal
However, neither the unilateral posterior McEvedy canal anteriorly, not for herniation but aneurysm of the
approach nor the anterior approach does, as only part of iliac or inferior epigastric arteries. This operation was
the musculature and fasciae are retracted. The inferior designed before the introduction of antisepsis to avoid
epigastric vasculature and posterior lamina transversalis the risk of peritonitis, which was previously encountered
fascia, which remain in situ, block the view. Unless they after celiotomies performed for proximal ligation
are disrupted or circumvented, neither of the latter (Hunterian).
approaches or subsequent repairs should be labeled Bogros observed, ‘‘The external iliac artery termi-
preperitoneal. nates without a serosal cover. ... The peritoneum
extending from the anterior abdominal wall to the iliac
Keywords Preperitoneal Æ Groin Æ Inferior epigastric fossa leaves in front a space 13.5 to 15.5 mm wide.’’
vessels `
Rouviere (1912) [3] added, ‘‘The outer layer of the
peritoneum, in the shape of a gutter, concave above and
behind, is in contact with the soft tissues of the iliac
fossa from 1 to 1.5 cm above the inguinal ligaments. The
Introduction peritoneum thus demarcates with a dihedral angle
formed by the fascia transversalis anteriorly and the
Preperitoneal, a term promoted 40 years ago by Nyhus fascia iliaca inferiorly, a triangular prismatic interval
and Condon [1], was preferred over properitoneal, pos- filled with adipose tissue called the space of Bogros.’’
Further, Bogros described the inferior epigastric
vessels as ‘‘first passing inferiorly, overlying the parent
R. C. Read external iliac vessels, then turning anteriorly to enter the
University of Arkansas for Medical Sciences, Little Rock, Ark.,
USA abdominal wall.’’ Morton (1841) [4] agreed and, like
E-mail: read@post.harvard.edu Cooper (1807) [5], described the transversalis fascia as
Tel.: +1 301 545-1934 bilaminar. In addition, the former stated that the infe-
Fax: +1 301 545-0323 rior epigastric vessels run between these layers. Mackay
Present address: R. C. Read (1889) [6] likewise observed penetration of the fascial
304 Potomac Street, Rockville, MD 20850, USA envelope by this vasculature. Retzius (1858) [7], unaware
2. 80
of Bogros’ lateral preperitoneal space, described a sim- (GPRVS), who made this preperitoneal exposure pop-
ilar one in the midline, anterior to the bladder and be- ular. Laparoscopists followed by adopting the essentials
`
hind the pubis. Rouviere (1912) [3] pointed out that the of his technique in their most widely used repair (TEP)
two communicated. [31].
Annandale (1876) [8] repeated Bogros’ operation, but In 1959, visiting professor John Bruce of Edinburgh
for herniae, amputating the inferior epigastric vessels. recommended to Nyhus that the operation of McEvedy
He described severing the inguinal and femoral sacs (1950) [32] would be better suited for most protrusions
flush with the peritoneal cavity. Bassini (1887) [9] fol- that are unilateral, even though it had been restricted to
lowed, but from below, preserving the vasculature, lay- cases of femoral herniation, which, being anteromedial
ing his triple layer on top, as did Halsted (1889) [10]. to the inferior epigastric vasculature, are easily dealt
Immediately after the introduction of antisepsis by with. This procedure begins {as modified by McNaught
Lister, there was enthusiasm in the U.K. for intraperi- (1956) [33] and Reay-Young (1956) [34]} with a sup-
toneal release of incarcerated and strangulated herniae, rainguinal transverse skin incision. The underlying
an operation that had been carried out, when taxis anterior rectus sheath and lateral abdominal muscula-
failed, intermittently since the Brahmins. Crompton ture with the transversalis fascia (anterior lamina) are
(1860) [11], Niven (1861) [12], and Annandale (1873) [13] then transected and retracted inferio-medially, leaving
were the leaders. Lawson Tait, a gynecologist, noting the the rectus muscle and its blood supply, the inferior epi-
ease of incidental femoral herniorrhaphy while operat- gastric vessels, behind.
ing for ovarian cyst, recommended ‘‘elective’’ median To reach the space of Bogros, Nyhus reported
abdominal section for reducible herniation [14]. ‘‘ligation of the inferior epigastric artery and vein were
Advantages emphasized were ease of pulling out rather routine.’’ [1] Later, he preserved them, performing his
than pushing back protrusions, access to Gimbernat’s iliopubic tract repair in front. Condon [35] with his
ligament, given the rare need for its incision to enlarge anterior variant did the same. Usher (1959) [36], the first
the defect, less hemorrhage since abnormal arteries can to undertake preperitoneal prosthetic repair of the groin
be seen, ease of intestinal resection, no risk of reductio (also from below, with parietalization of the spermatic
en masse, ease of repair, and lack of injury to the cord), did likewise. However, Rives (1967) [37] who
inguinal canal. followed, divided them, as did his students, Flament
In the U.S., Kelly (1898), chief of gynecology at et al. (2001) [38]. Nevertheless, other surgeons per-
Johns Hopkins, like Lawson Tait, repaired an incidental forming anterior preperitoneal prosthetic repair, e.g.,
femoral hernia. However, he employed intraperitoneally Schumpelick (1990) [39], Read (1993) [40], and Wantz
a glass marble [15], thus introducing, long before Lich- and Fischer (2002) [41] left the inferior epigastric vas-
tenstein and Shore (1974) [16], the prosthetic plug to culature alone. Similarly, Gilbert (2002) [42] insinuates
herniology. A number of surgeons, including Gillion the deep lamina of his prosthetic device deep to the
(1891) [17], Moschcowitz (1907) [18], Robins (1909) [19], blood vessels. Wantz (1991) [43], when he introduced his
Bates (1913) [20], LaRoque (1919) [21], and Wilkinson unilateral GPRVS through the modified McEvedy pos-
(1967) [22] adopted the posterior intraperitoneal terior preperitoneal approach, divided the epigastric
approach to reducible abdominal herniation before Ger vessels. He again, like Nyhus with his tissue repair, then
(1982) [23], who used it to introduce laparoscopic repair (1993) [44] left the vasculature alone.
of groin herniae.
Cheatle [24] was the first to perform posterior pre-
peritoneal repair of groin herniation, initially using a Discussion
paramedian or midline incision, later a Pfannenstiel
(1921) [25]. He introduced this approach ‘‘because a Both Nyhus and Wantz, the modern proponents of the
succession of cases from below presented difficulties in unilateral preperitoneal approach to the groin, included
the efficient excision of the sac which demonstrated an stylized illustrations (Fig. 1) taken from the Cheatle-
extraperitoneal component.’’ The inferior epigastric Henry procedure in descriptions of their posterior
vessels were retracted with the recti abdominis. Like McEvedy technique. Further, they portrayed amputa-
laparoscopists, 70 years later, he noted on the side tion of the inferior epigastric vessels, long after this
opposite to unilateral protrusion ‘‘unsuspected and maneuver had been discontinued in most of their
potential sacs (dimples).’’ Henry [26] rediscovered the patients. The impression conveyed was that the modified
operation that had been ignored. He emphasized pre- McEvedy operation provides the same exposure of the
peritoneal pouches with their true and false necks. preperitoneal space of Bogros as the Cheatle-Henry
Again, the procedure was not employed until Musgrove procedure. Thus, Wantz and Fischer (2002) [41]
and McCready (1949) [27] and Mikkelsen and Berne asserted, ‘‘Unilateral GPRVS is the Stoppa procedure
(1954) [28] used it, but only for unilateral femoral her- applied to a single groin.’’ If this is so, why, as history
nioplasty. Nyhus et al. (1959) [29] treated all groin her- has shown, does the vasculature block the view in the
niation with this approach as Cheatle and Henry had. unilateral but not the bilateral operation?
Nevertheless, it was Stoppa (1969) [30], encasing the The explanation lies in the original definition of
peritoneum with a prosthetic wrap in difficult cases preperitoneal, v. supra. This was based on anatomical
3. 81
transversalis fascia are elevated with the McEvedy pro-
cedure. The rectus muscle, which remains, is retracted
medially, but the inferior epigastric vessels are pulled
with it, and both they and the underlying posterior
lamina transversalis fascia cover the preperitoneal space
of Bogros (Fig. 3).
Thus, the median section in the Cheatle-Henry
operation immediately exposes the spaces of Retzius and
Bogros, while with the McEvedy approach, after only a
part of the abdominal wall is transected, further dis-
section is required. In particular, the posterior lamina,
transversalis fascia has to be disrupted medial and lat-
eral to the inferior epigastric vessels and the latter
amputated or circumvented. Only then can preperito-
neal division of hernial sacs be accomplished. Early in
my experience with preperitoneal herniorrhaphy (1967)
[47], I realized that there was a distinct difference be-
tween the two approaches. The McEvedy procedure was
labeled as pre-extraperitoneal to distinguish it from the
preperitoneal Cheatle-Henry. A better term for the for-
mer would have been prevascular.
Tissue or prosthetic repair with the Cheatle-Henry
approach is routinely conducted in the avascular, easily
cleaved preperitoneal space. Surgeons beginning to use
the modified unilateral McEvedy procedure did likewise
Fig. 1 Illustration of the view from the preperitoneal approach. In:
Nyhus LM, Condon RE (eds) (1995) Hernia, 4th Edition. by transecting the inferior epigastric vessels and pos-
Philadelphia: JP Lippincott Co, p 158 (with permission) terior lamina, transversalis fascia. However, later most
preserved the vasculature by removing the posterior
lamina around it and inserting sutures or mesh behind
the vessels. Nevertheless, Nyhus conducted his posterior
iliopubic tract repair in front of the vasculature. He
called it preperitoneal even though the identical anterior
iliopubic tract repair (Condon) was not so labeled. In
contrast, Wantz and Fischer described their unilateral
anterior prevascular (Fig. 4) and retrovascular mesh
placement as well as the posterior retrovascular insertion
GPRVS along with their original preperitoneal proce-
dure, which included division of the inferior epigastric
vessels.
This confusion in the use of the term preperitoneal is
not related to the fact that the Cheatle-Henry procedure
provides bilateral exposure, whereas the McEvedy is
unilateral. The latter was introduced and subsequently
used for a time only for femoral herniation, which arises
medial to the inferior epigastric vessels. If incision is
made lateral to them, as Ugahary (1998) [48] and Kugel
Fig. 2 Preperitoneal approach through the linea alba. Exposure is (2002) [49] do, the vasculature is no longer in the way,
internal to the inferior epigastric vessels retracted with the recti and the preperitoneal space is entered immediately, as in
abdomines [26] (reprinted with permission from Elsevier) the Cheatle-Henry approach.
The fundamental difficulty is therefore anatomical.
interpretations now known to be erroneous (Read 1992) The transversalis fascia can no longer be considered ‘‘a
[45]. The transversalis fascia has not one but two layers continuous layer of endoabdominal fascia which com-
that insert onto Cooper’s ligament. The inferior epi- pletely encloses the abdominal cavity’’ (Condon 1964)
gastric vessels pass between these two laminae, not [50] or ‘‘lining the abdominal cavity like a bag’’ (Lampe
through the preperitoneal space, which is avascular 1964) [51]. This role is filled by the preperitoneal fascia,
(Tyson and Reichle, 1972) [46]. Whereas, in the Cheatle- which had been described by a number of investigators
Henry approach, the entire abdominal wall (including deep to what they considered to be a monolaminar
the vasculature) is retracted (Fig. 2), only the anterior transversalis fascia attached to muscles, aponeuroses,
rectus sheath, lateral musculature, and anterior lamina and the bony framework of the abdominal wall
4. 82
Fig. 3 a Photograph and b
diagram of view through the
McEvedy approach.
A Retracted anterior rectus
sheath. B Pubic vein. C Inferior
epigastric vessels. D Secondary
internal inguinal ring.
E Preperitoneal fat in space of
Bogros. F Spermatic vessels
beneath posterior lamina
transversalis fascia. G Hernial
sac. H Internal abdominal ring.
I Rectus muscle and tendon.
J Posterior lamina transversalis
fascia. In: Nyhus LM, Condon
RE (eds) (1995) Hernia, 4th
Edition. J.P. Lippincott Co,
Philadephia, p 61 (with
permission)
(Mackay, 1889 [6]; Lytle, 1945 [52]; Lampe, 1964, [51] surgical, as opposed to cadaveric, dissection. He also
and Fowler, 1975 [53]). However, Arregui (1997) [54] has points out that the epigastric vessels supply the
identified laparoscopically a preperitoneal fascia beneath abdominal wall but not the underlying vas deferens,
which are the median and lateral umbilical ligaments. lateral umbilical ligaments, or bladder, which are nour-
This layer is the floor of the avascular preperitoneal ished by branches of the internal iliacs. These important
space. It is distinct from the overlying posterior lamina studies of Arregui, accomplished in the operating room,
of the transversalis fascia, which supports the inferior point to the continuing importance of surgical anatomy.
epigastric vasculature running in the abdominal wall Further, in the new age of laparoscopy and prosthetic
beneath the anterior lamina, transversalis fascia. He repair, they reinforce the concept that ‘‘the proper
states, ‘‘a proper preperitoneal dissection for laparo- anatomic location of groin herniorrhaphy’’ [55] may yet
scopic or open preperitoneal repair depends on a good be the preperitoneal space of Bogros.
understanding of these fasciae,’’ which are better seen by
Conclusion
The term preperitoneal should only be used to charac-
terize an approach to the groin if it provides enough
exposure of the space of Bogros beneath the inferior epi-
gastric vessels to allow herniation to be repaired therein.
Addendum One of the reviewers of this manuscript pointed out that
Henry Fruchaud, in the famous Anatomie Chirurgicale des Hernies
de l’aine (Paris: G. Doin, 1956) ‘‘seems to have a view similar to
yours expressed in two of the abundant figures of his book.’’ Since
his works have not been translated into English, I was unaware of
this foresight.
Conflict of interest: No information supplied
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