Clinical anatomy and physiology of the abdominal wall

Introduction

Novel surgical techniques and technologies (such as retromuscular repairs and robotic surgery) have allowed surgeons to better understand the different layers that constitute the abdominal wall and how they relate to each other. A comprehensive knowledge of these anatomical principles is paramount for successful hernia repair. Recognition of anatomical landmarks and limits will prevent potential neurovascular or structural injury caused by inappropriate dissection during robotic hernia repair.

Overview

The abdominal wall is a hexagonal area delineated superiorly by the xiphoid process and the edges of the costal margins, laterally by the quadratus lumborum, and inferiorly by the inguinal ligaments and the pubic bone. The most superficial layers of the abdominal wall are composed of the skin overlying Camper’s fascia, subcutaneous fat, and Scarpa’s fascia. These layers contain neurovascular structures and are anterior to the investing fascia of the abdominal wall muscles.

The anterolateral abdominal wall is a tri-laminar muscle structure present bilaterally. It is formed by the external oblique (EO), internal oblique (IO), and transversus abdominis (TA). The anterior abdominal wall is composed of the rectus abdominis (RA) and the variably present pyramidalis muscle.

Anterolateral abdominal wall