Original concepts in anatomy, abdominal-wall surgery, and component separation technique and strategy
| Autor: | Andrea Morlacchi, Giampiero Campanelli, Francesca Lombardo, C Andretto Amodeo, Marta Cavalli, Piero Giovanni Bruni |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Posterior component separation Incisional hernia Anterior component separation Rectus diastasis Dissection (medical) 030230 surgery Linea semilunaris Abdominal wall 03 medical and health sciences 0302 clinical medicine medicine Humans Incisional Hernia Hernia Fascia Compartment (pharmacokinetics) Herniorrhaphy Anterior compartment mobilisation Loss of substance Abdominal Muscles Aged Aged 80 and over business.industry Dissection Abdominal Wall Anatomy Middle Aged Plastic Surgery Procedures Surgical Mesh medicine.disease Hernia Ventral Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Diastasis business |
| Zdroj: | Hernia : the journal of hernias and abdominal wall surgery. 24(2) |
| ISSN: | 1248-9204 |
| Popis: | The abdominal wall can be considered comprised of two compartments: an anterior and a posterior compartment. The anterior compartment includes the anterior rectus sheath and the rectus muscle. The posterior compartment comprises the posterior rectus sheath, the transversalis fascia, and the peritoneum. When a large defect in the anterior compartment has to be corrected, for example, a rectus diastasis or large incisional hernia, an action on the anterior compartment is necessary; therefore, an anterior component separation has to be considered. If a loss of substance is present in the posterior compartment, a trasversus abdominis release should be accomplished. We propose an original anterior compartment mobilisation, by a posterior approach. Dissection of the posterior rectus sheet proceeds until the linea semilunaris is reached. Incision of the anterior rectus sheath permits a mobilisation of the anterior compartment by a posterior approach. A mesh is placed in a sublay position. If the abdominal wall presents a loss of substance of the posterior compartment, a transversus abdominis release (TAR) can be performed in the same time. No hernia recurrences, no wound infection, and no mesh infection have been reported. The anterior compartment mobilization permits mobilization towards the midline of rectus muscle and restoration of anterior compartment, with low morbidity rate; it can be easily associated to a large sublay mesh placement, it allows the preservation of the neurovascular bundles and rectus muscle trophism, and it can be associated with a concomitant TAR procedure for the restoration of the PC, if necessary. |
| Databáze: | OpenAIRE |
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