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| Titel: |
Anatomical and Surgical Considerations about Spiegel´s Line. |
| Auteur: |
Vicente Mitidieri Alejandro Mitidieri Adelina Coturel. |
| Verschenen in: |
Revista Argentina de anatomía online |
| Paginering: | Jaargang 1 (2010) nr. 2 pagina's 47-54 |
| Jaar: |
2010 |
| Inhoud: |
The “Spiegelian aponeurosis” is the portion of the transversus abdominis aponeurosis located between the semilunar line and the lateral border of the rectal sheath. Aponeurosis dimensions, weaker areas and their surgical significance were studied in 8 formolized cadavers, 30 abdominal wall US images and 6 patients. Given that the external oblique muscle-aponeurotic transition is lateral to the abdominal internal oblique transition, hernias usually take place between the internal and the external abdominal oblique muscle. Spangen described a “belt” between two parallel lines, from one to another anterior superior iliac spine (ASIS) to another parallel line 6 cm above. In our dissections the aponeurosis reaches their bigger dimensions between 0 and 18mm above the ASIS, and the maximum width is from 30 to 37mm. This widest area is located along 30 and 57mm cranially to the ASIS. Caudally, Spiegelian aponeurosis describes a curve medially towards the pubis; its maximum width reaches 12mm. This is where “low Spiegelian hernias” develop. Upwards, this aponeurosis becomes smaller and reaches the posterior layer of the rectus sheath at the level of the umbilicus. Thus, no truly Spiegelian aponeurosis exists at this point. Over the umbilicus, muscular fibers from the internal oblique have a vertical direction, whereas transversus fibers are axial, thus providing this area with a strong abdominal wall. Caudally, internal oblique fibers become transverse, parallel to those of the transversus abdominis. In case muscular fibers are not strong enough, Spiegelian hernia would develop, maybe because of the presence of increased fatty tissue between muscular fibers which allows preperitoneal fat and ulteriorly abdominal contents to raise through the abdominal wall. A preperitoneal polypropylene mesh should replace the lack of resistance of transversus abdominis and internal oblique. This mesh should be big enough to reinforce the area between the ASIS and the umbilical plane. The concept of Spangen´s belt is relevant to improve an accurate diagnosis and treatment of these hernias. |
| Uitgever: |
Asociacion Argentina de Anatomia (provided by DOAJ) |
| Bronbestand: |
Elektronische Wetenschappelijke Tijdschriften |
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