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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_718_Библиотеки_им_академика_М_И_Перельмана
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A.V. Protasov, M.Sh.F. Mekhaeel,
S.M.A. Salem, M.Y. Persov
HERNIA BETWEEN
TOPOGRAPHY AND SURGERY
Moscow
Peoples’ Friendship University of Russia
named after Patrice Lumumba
2024
УДК 616.34-007.43-08(035.3)
ББК ,54*54.1–57.3
Г91
доктор медицинских наук, профессор, заведующий кафедрой хирургии
медико-биологического факультета ФГАОУ ВО РНИМУ им. Н.И. Пирогова
Минздрава России (Пироговский Университет) А.И. Черепанин;
доктор медицинских наук, профессор кафедры экспериментальной
и клинической хирургии медико-биологического факультета
ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России
(Пироговский Университет) В.А. Горский
Российского университета
Рецензенты:
Авторы:
У т в е р ж д е н о
РИС Ученого совета
дружбы народов
А.В. Протасов, М.Ш.Ф. Mекхаeэль, С.М.А. Салем, М.Ю. Персов
Г91 Грыжа между топографией и хирургией = Hernia
between topography and surgery : монография / А. В. Прота-
сов, М .Ш. Ф. Mекхаeэль, С. М. А. Салем, М. Ю. Персов. –
Москва : РУДН, 2024. – 232 с. : ил.
В монографии рассмотрены основные принципы топографической
анатомии, различные виды грыж и методы их лечения. Описаны хирургические инструменты, используемые при операциях по удалению грыж,
а также классификация шовных материалов и материалов для сетчатых
имплантатов, используемых для герниопластики.
Издание предназначено для студентов-медиков, врачей-ординаторов
и аспирантов по общей хирургии.
This monography discusses the basic principles of topographic anatomy,
various types of hernias and methods of their treatment. It describes surgical
instruments used in hernia repair, as well as the classification of suture
materials and materials for mesh implants used for hernioplasty.
The publication is intended for medical students, residents and PhD
students in general surgery.
ISBN 978-5-209-12485-6 © Протасов А.В., Mекхаeэль М.Ш.Ф.,
Салем С.М.А., Персов М.Ю., 2024
© Оформление. Российский университет
дружбы народов, 2024
TABLE OF CONTENTS
INTRODUCTION ………………………………………………………………………. 4
CAHAPTER ONE: THE ANTEROLATERAL ABDOMINAL
WALL.TOPOGRAPHO-SURGICAL ANATOMY, EXPLANATION.
A.V. Protasov, M.Sh.F. Mekhaeel, S. Sameh ………………………………………… 5
CHAPTER TWO: ANTEROLATERAL ABDOMONAL WALL HERNIAS.
A.V. Protasov, M.Y. Persov, M.Sh.F. Mekhaeel, S. Sameh …………………………. 34
CHAPTER THREE: THE ABDOMONAL CAVITY.TOPOGRAPHO-SURGICAL
ANATOMY, CLINICAL NOTES.
M.Sh.F. Mekhaeel, S. Sameh ………………………………………………………….. 63
CHAPTER FOUR: INTERANAL ABDOMINAL HERNIAS.
A.V. Protasov, M.Sh.F. Mekhaeel, S. Sameh ………………………………………… 123
CHAPTER FIVE: THE RETROPERITONEAL SPACE. TOPOGRAPHO-
SURGICAL ANATOMY, EXPLANATION.
M.Sh F. Mekhaeel, S. Sameh ………………………………………………………….. 134
CHAPTER SIX: RETROPERITONEAL HERNIAS.
M.Y. Persov, M.Sh.F. Mekhaeel, S. Sameh …………………………………………... 147
CHAPTRER SEVEN: THE PELVIC CAVITY.TOPOGRAPHO-SURGICAL
ANATOMY, REVISIONAL NOTES.
M.Sh.F. Mekhaeel, S. Sameh ………………………………………………………….. 149
CHAPTER EIGHT: PELVIC HERNIAS.
A.V. Protasov, M.Sh.F. Mekhaeel, S. Sameh ………………………………………… 166
CHAPTER NINE: THE PERINEUM.TOPOGRAPHO-ANATOMICAL
EXPLANATION.
M.Sh.F. Mekhaeel, S. Sameh ………………………………………………………….. 171
CHAPTER TEN: PERINEAL HERNIAS.
M.Y. Persov, M.Sh.F. Mekhaeel, S. Sameh …………………………………………... 188
CHAPTER ELEVEN: SURGICAL INSTRUMENTS USED IN HERNIA
SURGERY.
M.Sh.F. Mekhaeel, S. Sameh ………………………………………………………….. 190
CHAPTER TWELVE: TYPES OF MESH IMPLANTS AND THEIR PROPERTIES.
A.V. Protasov, M.Sh.F. Mekhaeel, S. Sameh ………………………………………… 201
SOURCES ………………………………………………………………………………. 206
3
INTRODUCTION
The Latin word “prolapse” is the origin of the term “hernia”. In the year 1552 BC in ancient Egypt,
the earliest evidence of inguinal hernia was recorded. Henri Fruchaud was the first to use the term
“groin hernia” in the early 1950’s of the last century.
The annual incidence of abdominal hernias worldwide is more than 20milloin cases. In Russia the
incidence is 20.9%. Inguinal hernias are considered as the commonest surgical disease to be
repaired worldwide, accounting for (75%) of abdominal wall hernias, with more over 300 methods
of repair had been invented.
The first attempts of dealing with hernia were carried by Pierre Franco and Ambroise Paré, where
they used conservative treatments with a strong bandage. In the 18th century, specific anatomical
structures in the inguinal canal were clarified. In 1716, Demetrius Cantemir was the first to do a
successful Transabdominal repair. Lorenz Heister was the first to report a successful bowel
resection via laparotomy for a strangulated hernia.
Postoperative complications of hernia repair include Seroma, hematoma, urinary retention,
neuralgias, testicular pain and swelling, surgical site infection, mesh migration, foreign body
sensation and recurrences.
The average cost of hernia repair surgery—with or without mesh—in the United States is $7,750,
though prices can range from $3,900 to $12,500. The average cost for an inpatient hernia repair is
$11,500, while the average cost for an outpatient procedure is $6,400.
More than 150 types of mesh implant materials are used nowadays for hernioplasty. Among many
classification systems of mesh implants, the uniquely of Deeken & Lake Mesh Classification
system, is its dependence on clarifying the nuances in order to explain the properties of the
materials used, thus classifying them the according to scaffold material into three main groups:
permanent synthetic, resorbable, and biological tissue-derived materials.
Therefore, in an attempt to better understating of the surgical and topographic anatomy of the
anterolateral abdominal wall, abdominal cavity as well as the posterior abdominal wall,
demonstrating types of external and internal abdominal hernias anatomy, clinical presentation,
examination, various surgical procedures and technique together with highlighting the surgical
instruments used for hernia repair, the authors presented this manual.
4
CAHAPTER ONE: THE ANTEROLATERAL ABDOMINAL WALL.TOPOGRAPHO-
SURGICAL ANATOMY, EXPLANATION.
A.V Protasov ,M.Sh F. Mekhaeel ,S.Sameh
¾ Limits of the anterolateral abdominal wall:
1.Superior:
Margins of the lower 6 costal arches and the xiphoid process.
Fig. 1: Superior limit of the anterolateral abdominal wall. Source [1].
2.Lateral (From the flanks):
Vertical Lines extending from the anterior ends of the XI pair of ribs to the iliac crest, as a
continuation of the mid-axillary line.
Fig. 2: Lateral limits of the anterolateral abdominal wall. Source [2].
5
3.Inferior:
Iliac crest, inguinal folds and superior border of pubic bones.
Fig. 3: Inferior limits of the anterolateral abdominal wall. Source [3].
¾ Walls:
1.Superior wall: Diaphragm.
Fig. 4: Superior wall of the anterolateral abdominal wall (The diaphragm). Source [4].
2.Inferior wall:
Linea Terminalis
¾ Linea Terminalis represent the antero-lateral borders of the pelvic inlet, which is a circular
opening between abdominal and pelvic cavities allowing the passage of structures between
both cavities.
6
¾ Pelvic inlet consists of:
1. Linea Terminalis (Anterolaterally).
2. Pelvic promontory.
3. The margin of the ala of S1 joint.
Linea Terminalis is formed from:
1. Pubic crest.
2. Pecten pubis.
3. Arcuate line.
Fig. 5: Inferior wall of the anterolateral abdominal wall (Pelvic inlet and Linea terminalis). Source [5].
3.Posterior Wall:
Lumbar vertebrae and Lumbar muscles.
4.Anterolateral wall:
Anterolateral abdominal wall muscles.
CLINCAL NOTE: The abdominal walls don’t correspond with the surface landmarks of the
abdomen, because its’ superior wall ‘The diaphragm” enters the theocratic cavity as the
“CUPOLA”, while inferiorly the abdominal cavity extends towards the lesser pelvis. Therefore,
some abdominal organs extend beyond the ribs within the intercostal space; Liver, Spleen,
Adrenals, while the loops of the intestine descend into the lesser pelvic cavity. Therefore,
abdominal walls go beyond its surface landmarks.
7
¾ Surface Landmarks:
1.The costal arch
Which is formed by the cartilages of the VII-X ribs on both sides of the xiphoid process along with
forming the infrasternal angles, angulus infrasternalis.
2.Xyphoid process (Processus xiphoides)
Below the body of the sternum.
Fig. 6: The costal arch and xyphoid process. Source [6].
3.Pelvic bones:
1. Iliac crest, crista iliaca.
2. Anterior superior iliac spine, spina iliaca anterior superior.
3. The superior border of the pubis.
4. The pubic tubercle, tuberculum pubicum.
Fig. 7: Pelvic bones. Source [7].
8
4.The umbilicus (Navel).
A retracted scar at the site of the umbilical ring. The umbilical ring is a slit in the white line with
sharp and even edges formed by the tendon fibers of the aponeuroses of all the broad abdominal
muscles. In the prenatal period, the umbilical cord passes, connecting the fetus with the mother's
body.
The umbilicus is composed of four distinct anatomical structures: the mamelon, cicatrix, cushion
and furrows.
1. The mamelon is the area of the central hump of the umbilicus.
2. The cicatrix forms the dense scar and is a fusion of several peritoneal and fibrous structures
(round ligament of liver, median umbilical ligament, two medial umbilical ligaments,
transversalis fascia, umbilical fascia and parietal peritoneum).
3. The cushion of the umbilicus is the slightly raised skin margin which surrounds the
mamelon and cicatrix.
4. Finally, furrows stand for the depressions inside the cushion, surrounding the mamelon.
Fig. 8: Anatomical structure of the umbilicus. Source [8]
Lies nearly midway between the xiphoid process and the pubic symphysis.
The umbilicus forms the fibrous remnant of the end of the umbilical cord in the form of a skin scar
lying nearly midway between xiphoid process and the pubic symphysis at the linea alba.
It was the access of the umbilical vein (oxygenated blood) and 2 umbilical arteries (Deoxygenated
blood).
The umbilical ring is a dense fibrous ring surrounding the umbilicus at birth. At about the sixth
week of embryological development, the midgut herniates through the umbilical ring; six weeks
later it returns to the abdominal cavity and rotates around the superior mesenteric artery.
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