Retraction of External oblique, internal oblique, and transversus abdominis muscles laterally is done during which surgery? (AIIMS Nov 2012)
|A||Laparoscopic kidney surgery approach|
|B||Classical exposure of kidney|
|C||Lumbotomy for renal cyst|
|D||Spigelian hernia repair|
a. A variety of interparietal hernia occurring at the level of the arcuate line.
b. Very rare
c. The fundus of the sac, clothed by extraperitoneal fat, may lie beneath the internal oblique muscle where it is virtually impalpable.
d. Usually over 50 years of age, M:F 1:1
e. Typically, a soft, reducible mass encountered lateral to the rectus muscle and below the umbilicus.
f. Diagnosis is confirmed by computerized tomography (CT) or ultrasound scanning, the latter havig the advantage of being able to stand the patient upright if no defect is visible in the reclining position.
g. Owing to the rigid fascia surrounding the neck, strangulation may occur.
Treatment –Operation –
a. If a defect is palpable, a muscle-splitting approach is used.
b. After isolating the sac, dealing with any contents, and ligating and excising it, the transversus, internal oblique and external oblique muscles are repaired by direct apposition.
c. If no sac is palpable, a paramedian approach is used and the sac sought in the extraperitoneal space. The repair then proceeds as described above