RT Book, Section
A1 Seymour, Neal E.
A1 Bell, Robert L.
A2 Brunicardi, F. Charles
A2 Andersen, Dana K.
A2 Billiar, Timothy R.
A2 Dunn, David L.
A2 Hunter, John G.
A2 Matthews, Jeffrey B.
A2 Pollock, Raphael E.
SR Print(0)
ID 1117751390
T1 Abdominal Wall, Omentum, Mesentery, and Retroperitoneum
T2 Schwartz's Principles of Surgery, 10e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071796743
LK accessmedicine.mhmedical.com/content.aspx?aid=1117751390
RD 2024/04/18
AB There  are  important  anatomic  differences  in  the  rectus  sheath  structures  above  and  below  the  arcuate  line.  The  laminae  of  the  internal  oblique,  which  contribute  to  both  the  anterior  and  (along  with  the  transversus  abdominis)  posterior  rectus  above  the  arcuate  line,  only  contribute  to  the  anterior  sheath  below  the  arcuate  line.  There  is  no  aponeurotic  posterior  covering  on  the  lower  portion  of  the  rectus  muscles.Rectus  diastasis  is  associated  with  abdominal  wall  bulging  consequent  to  separation  of  the  rectus  abdominis  muscles  in  the  midline.  It  does  not  represent  a  hernia,  and  surgical  interventions  for  this  condition  are  of  questionable,  if  any,  clinical  benefit.When  resection  of  abdominal  wall  desmoid  tumors  is  undertaken,  it  must  be  recognized  that  failure  to  achieve  negative  margins  is  associated  with  an  extremely  high  risk  of  local  recurrence  of  the  tumor.Primary  repair  of  ventral  incisional  hernias  is  associated  with  unacceptably  high  failure  rates,  and  repair  using  other  approaches,  such  as  use  of  prosthetic  mesh,  is  preferred.The  addition  of  the  closed  videoscopic  technique  to  components  separation  procedures  has  been  associated  with  a  significant  decrease  in  the  incidence  of  local  wound  complications.Potential  benefits  of  laparoscopic  incisional  hernia  repairs  compared  to  open  repairs  with  mesh  include  shorter  hospitalization,  lower  risk  of  wound  complications,  and  better  abdominal  wall  function.  A  lower  recurrence  rate  benefit  remains  controversial.Surgical  treatment  of  sclerosing  mesenteritis  is  most  often  undertaken  to  confirm  diagnosis  and  to  rule  out  neoplasm  as  the  cause  of  a  mesenteric  mass.  Resection  possibilities  are  limited  by  the  extensiveness  of  the  process  as  well  as  by  the  questionable  benefit  in  most  cases.Potential  surgical  interventions  in  retroperitoneal  fibrosis  include  operative  biopsy  to  rule  out  neoplasm,  ureteral  stent  placement,  open  or  laparoscopic  ureterolysis,  and  endovascular  interventions  for  iliocaval  occlusion.