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Computed Tomography and Gross Anatomy of the Abdominal Wall (Including Planes for Mesh Hernia Repair)

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The SAGES Manual of Hernia Surgery

Abstract

A comprehensive understanding of abdominal wall anatomy, both gross and radiographic, is essential for any surgeon who plans to perform ventral herniorrhaphy. As the volume and complexity of ventral hernias increase, hernia surgeons must be well versed in the correlation of physical exam findings with imaging study findings to most effectively plan for operative intervention. This chapter provides a focused review of gross anatomy for hernia surgeons. It also reviews the importance of computed tomography imaging in the diagnosis and surgical management of ventral hernias and provides images and identifies key findings on interpretation. Finally, it describes the major classification systems of hernia location and mesh implantation to improve communication and research among surgeons who perform ventral herniorrhaphy.

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Author information

Authors and Affiliations

  1. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Ryan M. Juza & Eric M. Pauli

Authors
  1. Ryan M. Juza
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  2. Eric M. Pauli
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Corresponding author

Correspondence to Eric M. Pauli .

Editor information

Editors and Affiliations

  1. Emory University, Atlanta, GA, USA

    S. Scott Davis, Jr.

  2. Weill Med College At Cornell University, New York, NY, USA

    Gregory Dakin

  3. Stony Brook Surgical Associates, Centereach, NY, USA

    Andrew Bates

Appendix: CT Atlas

Appendix: CT Atlas

  1. 1.

    Wrinkled coated heavyweight polypropylene mesh (intermittently visible) is best identified where it is in contact with preperitoneal fat and as a result of the wrinkles from mesh contracture.

  2. 2.

    Thin expanded polytetrafluoroethylene mesh (small arrow), recurrent hernia in the midline (large arrow), and laparoscopic tacks (opaque dots).

  3. 3.

    Onlay mesh easily visible above the anterior rectus sheath due to interposed fat between the mesh and the fascia as well as by the presence of skin staples that were used to secure the mesh.

  4. 4.

    Laparoscopically placed left inguinal hernia mesh (lightweight polypropylene) visualized by fat density surrounding the mesh as well as by the metal tacks used to secure it.

  5. 5.

    Retromuscular polyethylene poorly visualized when in contact with the rectus muscle but that are visualized when adjacent to preperitoneal fat. Metal clips within the posterior sheet also hint as to the location in which dissection has occurred.

  6. 6.

    Heavyweight mesh visible on the abdominal wall and seen free floating in the abdominal cavity after failed ventral incisional hernia repair.

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© 2019 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Juza, R.M., Pauli, E.M. (2019). Computed Tomography and Gross Anatomy of the Abdominal Wall (Including Planes for Mesh Hernia Repair). In: Davis, Jr., S., Dakin, G., Bates, A. (eds) The SAGES Manual of Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-78411-3_11

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  • DOI: https://doi.org/10.1007/978-3-319-78411-3_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-78410-6

  • Online ISBN: 978-3-319-78411-3

  • eBook Packages: MedicineMedicine (R0)

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