1. Musculoaponeurotic anatomic features of the abdominal
wall layers differ superior to and inferior to the arcuate line
on the posterior aspect of the rectus sheath.
2. Defects of the complex process of abdominal wall development
in the fetus can occur in several ways resulting in persistent midgut
herniation (omphalocele and gastroschisis) or vitelline duct remnant abnormalities
(Meckel’s diverticulum, or vitelline duct fistula or cyst).
3. The management of rectus sheath hematomas consists of reversal
of any anticoagulation or coagulopathy and observation, unless either
hemodynamic instability or enlargement necessitates surgical evacuation.
4. Incisional hernias of the anterior abdominal wall may occur in
up to 10–20% of prior abdominal operations of
5. Primary suture repair of abdominal wall incisional hernias is
associated with an unacceptably high incidence of hernia recurrence,
and has prompted the wide use of prosthetic mesh materials for hernia repair.
6. Laparoscopic incisional hernia repair offers important advantages
over open repairs including reduced pain medication use, earlier
return to normal function, and possibly superior protection from hernia
7. Sclerosing mesenteritis is a poorly understood mesenteric process
characterized by variable degrees of inflammation and fibrosis within
mesenteric tissues of the small and large bowel, which frequently
requires surgical biopsy to rule out neoplasm and to establish the
8. Retroperitoneal fibrosis is a primary or secondary fibroproliferative
process in the retroperitoenum characterized by distortion of retroperitoneal structures,
including the ureters and inferior vena cava.
9. Treatment of retroperitoneal fibrosis may include ureterolysis
or ureteral stenting, and medical therapies such as corticosteroids
The abdominal wall is defined superiorly by the costal margins, inferiorly
by the symphysis pubis and pelvic bones, and posteriorly by the
vertebral column. It serves to support and protect abdominal and retroperitoneal
structures, and its complex muscular functions enable twisting and
flexing motions of the trunk. Surgical implications of abdominal
wall structure become apparent during the course of managing primary
abdominal wall diseases or gaining access to the peritoneal cavity.
A surgeon must have a thorough understanding of the arrangement
of abdominal wall muscles and aponeuroses.
The abdominal wall is an anatomically complex, layered structure with
segmentally derived blood supply and innervation (Fig.
35-1). It is mesodermal in origin and develops as bilateral
migrating sheets that originate in the paravertebral region and
envelop the future abdominal area. The leading edges of these structures
develop into the rectus abdominis muscles, which eventually meet
in the midline of the anterior abdominal wall. The muscle fibers
of the rectus abdominis are arranged vertically and are encased
within an aponeurotic sheath, the anterior and posterior layers
of which are fused in the midline at the linea alba. The
rectus abdominis has insertions on the symphysis pubis and pubic ...