1 Introduction ▴ Patients presenting for elective hernia repair often possess risk factors for wound morbidity and hernia recurrence that the surgeon cannot mend. Defect size, age, multiplicity of recurrences, and the presence of an ostomy or infected prosthetic are…
1 Clinical Anatomy ▴ The preperitoneal plane lies between the peritoneum and the posterior lamina of the transversalis fascia. There are two spaces that are of particular interest in the laparoscopic repair of inguinal hernias: the space of Retzius, the…
1 Clinical Anatomy ▴ Inguinal anatomy is notoriously challenging for the most experienced surgeon. The presence of major neurovascular structures in the retroperitoneum can make safe dissection challenging, particularly for the novice surgeon. ▴ This chapter provides a stepwise approach…
The transverse rectus abdominis musculocutaneous (TRAM) flap is a popular option for breast reconstruction. As an autogenous flap, TRAM flap breast reconstruction eliminates the risk of implant-related complications, provides soft tissue that mimics a natural breast, and provides a favorable…
1 Clinical Anatomy ▴ An umbilical hernia ( Fig. 20.1 ) occurs when contents of the abdomen pass through a defect in the abdominal wall at or near the umbilicus. When umbilical hernias occur in infants, surgical repair is generally…
1 Clinical Anatomy ▴ The abdominal wall is composed of four paired muscle groups: rectus abdominus, external oblique, internal oblique, and transversalis ( Fig. 19.1 ). The rectus muscles are separated by the linea alba, which is a fascia extending…
1 Preoperative Considerations ▴ Management of the open abdomen begins with the decision to open the abdomen. Practice patterns have evolved from an era where management of an open abdomen was extremely rare to a culture of damage control surgery…
1 Preoperative Considerations 1 Risk Stratification ▴ Smoking, uncontrolled diabetes, chronic obstructive pulmonary disease, morbid obesity, immunosuppression, long-term use of steroids, advanced age, and malnutrition (serum albumin <2.0 g/dL) increase the risk for surgical site infections and can compromise abdominal…
1 Clinical Anatomy 1 Features and Characteristics of Defect ▴ Definition of loss of abdominal domain: There is no consensus in the literature on the definition of loss of abdominal domain. Determination of this condition is subjective and typically refers…
1 Surgical Anatomy ▴ The robotic platform enables exploitation of the individual layers of the abdominal wall. Although it is possible to do this with conventional laparoscopic instrumentation, working high on the anterior abdominal wall remains technically challenging. ▴ It…