The Abdominal Wall And Hernias, Summaries of General Surgery

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The Abdominal Wall

The Abdominal Wall

And Hernias

And Hernias

Stanley Kurek, DO, FACS

Stanley Kurek, DO, FACS

Associate Professor of Surgery

Associate Professor of Surgery

UTMCK

UTMCK

The Abdominal Wall The Abdominal Wall

‹ ‹

The structure of the abdominal wall is similar in

The structure of the abdominal wall is similar in

principle to the thoracic wall.

principle to the thoracic wall.

‹ ‹

There are three layers, an external, internal and

There are three layers, an external, internal and

innermost layer.

innermost layer.

‹ ‹

The vessels and nerves lie between the internal

The vessels and nerves lie between the internal

and innermost layers.

and innermost layers.

1:Right Hypochondriac Region; 2:Right Lumbar Region; 3:R. Iliac (Inguinal) Region

;

4:Epigastric Region; 5:Unbilical Region; 6:Hypogastric (Pubic) Region;7:Left Hypochondriac Region; 8:Left Lumbar Region; 9:Left Iliac (Inguinal) Region

The Fascia The Fascia

‹ ‹

Below the skin the superficial fascia is divided into a Below the skin the superficial fascia is divided into a

superficial fatty layer, Camper's fascia, and a deeper superficial fatty layer, Camper's fascia, and a deeper

fibrous layer, fibrous layer,

Scarpa's Scarpa's

fascia.fascia.

‹ ‹

The deep fascia lies on the abdominal muscles. Inferiorly The deep fascia lies on the abdominal muscles. Inferiorly

Scarpa's Scarpa's

fascia blends with the deep fascia of the thigh. fascia blends with the deep fascia of the thigh.

This arrangement forms a plane between This arrangement forms a plane between

Scarpa's Scarpa's

fascia fascia

and the deep abdominal fascia extending from the top of and the deep abdominal fascia extending from the top of

the thigh to the upper abdomen. the thigh to the upper abdomen.

‹ ‹

Below the innermost layer of muscle, the Below the innermost layer of muscle, the

transversus transversus

abdominis abdominis

muscle, lies the muscle, lies the

transversalis transversalis

fascia. The fascia. The

transversalis transversalis

fascia is separated from the parietalfascia is separated from the parietal

peritoneum by a variable layer of fat. peritoneum by a variable layer of fat.

Rectus Rectus Abdominis

Abdominis

External Abdominal Oblique Muscle External Abdominal Oblique Muscle

‹ ‹

The The

external oblique muscle external oblique muscle

arises from the lower eightarises from the lower eight

ribs. ribs.

‹ ‹

The fibers run downwards and forwards to form an The fibers run downwards and forwards to form an

aponeurosis aponeurosis

anteriorly anteriorly

‹ ‹

The The

aponeurosis aponeurosis

passes passes

anteriorly anteriorly

to the rectus muscle toto the rectus muscle to

insert into the insert into the aponeurosis

aponeurosis

from the other side at the from the other side at the

linea linea

alba. alba.

‹ ‹

Inferiorly the Inferiorly the

aponeurosisaponeurosis

inserts into the anterior superior inserts into the anterior superior

iliac spine and stretches over to the pubic tubercle, forming iliac spine and stretches over to the pubic tubercle, forming

the the

inguinal ligamentinguinal ligament

. .

Internal Oblique Muscle Internal Oblique Muscle

‹ ‹

The The

internal oblique muscle internal oblique muscle

arises from the lumbar arises from the lumbar

fascia, the iliac crest and the lateral two fascia, the iliac crest and the lateral two

thirds of the thirds of the

inguinal ligament and runs upwards and forwards to form inguinal ligament and runs upwards and forwards to form

an an

aponeurosis aponeurosis

‹ ‹

Above the Above the

arcuatearcuate

line the line the

aponeurosis aponeurosis

splits to enclose the splits to enclose the

rectus muscle. rectus muscle.

‹ ‹

Below the Below the

arcuate arcuate

line theline the

aponeurosis aponeurosis

passes anterior to passes anterior to

the rectus muscle. the rectus muscle.

‹ ‹

The inferior part of the The inferior part of the

aponeurosis aponeurosis

inserts into the inserts into the

symphysis symphysis

pubis. pubis.

‹ ‹

At this insertion the At this insertion the

aponeurosisaponeurosis

is fused with the is fused with the

aponeurosis aponeurosis

of the of the

transversus transversus

abdominis abdominis

muscle to form muscle to form

the the

conjoint tendon.conjoint tendon.

Internal Abdominal Oblique Internal Abdominal Oblique

Transversus Transversus

Abdominis Abdominis

The

The

transversus transversus

abdominis

abdominis

muscle muscle

arises from the lower six costal

arises from the lower six costal

cartilages, the lumbar fascia and the

cartilages, the lumbar fascia and the

iliac crest.

iliac crest.

Tranversus Tranversus

Abdominis Abdominis

Inguinal Ligament Inguinal Ligament

The inguinal ligament is formed by the

The inguinal ligament is formed by the

aponeurotic

aponeurotic

fibers of the external oblique

fibers of the external oblique

muscle.

muscle.

The ligament stretches from the anterior

The ligament stretches from the anterior

superior iliac spine (ASIS) to the pubic

superior iliac spine (ASIS) to the pubic

tubercle.

tubercle.

At the medial end of the inguinal ligament,

At the medial end of the inguinal ligament,

fibers are reflected backwards to insert

fibers are reflected backwards to insert

into the superior

into the superior

ramus

ramus

of the pubis,

of the pubis,

forming the

forming the

lacunar

lacunar

ligament.

ligament.