D R M A RYA M A L A M K H A NM B B S , F C P S

S U R G I C A L E WA R DK H Y B E R T E A C H I N G H O S P I TA L

SURGICAL-ANATOMY OF ANTERIOR

ABDOMINAL WALL

• Anatomical landmarks• Anatomical planes• Quadrants and regions • Dermatomes • Muscles and rectus sheath• Layers of abdominal wall• Inguinal canal• Femoral canal• Laparoscopic anatomy

LANDMARKS

1. Xiphoid process. 2. Costal margin. 3. Tip of the ninth costal cartilage. 4. Tendinous intersections. 5. Umbilicus. 6. Iliac crest. 7. Anterior superior iliac spine. 8. Linea semilunaris. 9. Linea alba. 10. Inguinal ligament. 11. Pubic tubercule. 12. Pubic crest. 13. Pubic symphysis.

THE ANATOMICAL PLANESHORIZONTAL PLANES

XIPHISTERNAL PLANE=T9SUBCOSTAL PLANE=L3SUPRACRISTAL PLANE= L4 TRANSTUBERCULAR PLANE=L5INTERSPINOUS PLANE VERTICAL PLANES

MidlineTwo Paramedian Planes

(Mid Clavicular Line/ Mammary Line)

THE QUADRANTS AND REGIONS

DERMATOMES

VENOUS AND NERVE SUPPLY

LYMPHATIC SUPPY

FASCIAL LAYERS

LAYERS OF ABDOMINAL WALL

THE EXTERNAL OBLIQUE MUSCLE

THE INTERNAL OBLIQUE MUSCLE

THE TRANSVERSUS ABDOMINIS

THE RECTUS ABDOMINIS MUSCLE

THE RECTUS SHEATH

THE INGUINAL CANAL

THE INGUINAL LIGAMENT

THE SPERMATIC CORDThree fasciae:  External spermatic (from external oblique fascia)  Cremasteric (from internal oblique muscle and fascia)  Internal spermatic (from transversalis fascia)Three arteries:  Testicular artery  Cremasteric artery  Deferential arteryThree veins:  Pampiniform plexus and testicular vein  Cremasteric vein  Deferential veinThree nerves:  Genital branch of genitofemoral nerve  Ilioinguinal nerve  Sympathetic nerves (testicular plexus)Lymphatics

HASSELBACH’S TRIANGLE

THE NERVES OF INGUINAL REGION

THE FEMORAL CANAL

THE FEMORAL HERNIA

THE ABBERANT OBTURATOR ARTEY

THE ABDOMINAL WALL FROM INSIDE

SPACE OF BOGROS AND RETRO-PUBIC SPACE OF RETZIUS

LAPAROSCOPIC ANATOMY

LAPAROSCOPIC ANATOMY

LAPAROSCOPIC ANATOMY

THE TRIANGLE OF DOOM

THE TRIANGLE OF PAIN

THE CIRCLE OF DEATH