This book offers a complete focus on the radiographic analysis of the abdominal wall and hernias. An estimated 20 million hernias are repaired annually throughout the world. As the technology utilized to complete hernia repairs becomes more complex, surgeons are required to have a more thorough understanding of the radiographic anatomy and diagnostic modalities used to evaluate hernias. Furthermore, the amount that now goes into the preoperative planning of hernias for complex repairs (such robotic and open transversus abdominis muscle release procedures) requires an understanding of radiology and the ability to identify nuances of anatomy offered by the imaging. The use of mesh and extent of re-do hernia repairs has also complicated radiographic evaluation of hernias.
The text is a comprehensive review of abdominal wall imaging broken down into individual types of hernia. Each hernia type is discussed with consideration to the best type of imaging evaluation, unique radiographic findings and considerations prior to repair. Representative images, diagrams and videos are used to point out anatomy and features of the hernia. This text offers the first-of-its-kind standardized approach to evaluating hernias radiographically. Most importantly, each hernia and chapter is approached with the surgeon in mind, meaning, authors explain the radiology based on anatomy and with a plan for surgical repair on the horizon. Select chapters include illuminating videos to give context to the text.
This is an ideal guide for practicing surgeons and trainees treating patients with hernias.
Author(s): Salvatore Docimo Jr., Jeffrey A. Blatnik, Eric M. Pauli
Publisher: Springer
Year: 2023
Language: English
Pages: 413
City: Cham
Preface
Contents
Contributors
1: Computed Tomography (CT) Scan Basics
Why CT Imaging?
How Do We Get CT Images?
Slice Thickness and Multiplanar Reconstruction (MPR)
Window Width and Window Level
Contrast
CT Dose and Exposure Mitigation
Challenges of Imaging Large Patients
Imaging Artifacts on CT
References
2: Magnetic Resonance Imaging (MRI) Basics
Introduction
Basic MRI Principles
Normal Pelvic Anatomy on MRI
MRI Protocol for Groin Pain
MRI Pathology
Osteitis Pubis
Rectus Abdominis Strain
Adductor Tendon Syndromes
Rectus Abdominis/Adductor Aponeurosis Injury
Rectus Abdominis/Adductor Aponeurotic Plate Disruption
Inguinal Hernias
Confounding Pathologies
Conclusion
Bibliography
3: Ultrasonography Basics
Introduction
Patient Selection
Ultrasound Scanning
General Overview
Ultrasound Probe Options
Console Basics
Ultrasound Procedure
Clinical Pearls
Bibliography
Suggested Readings
4: Standardizing the Approach to Hernia Radiology
Introduction
Standard Imaging Techniques
Diagnosis of Hernia
Preoperative Evaluation and Surgical Planning
Intraoperative Care
Postoperative Management and Assessment for Complications
Long-term Follow-up and Evaluation for Recurrence
Advanced Image Processing Techniques and Radiomics
Standardized Reporting of the Abdominal Wall
Conclusion
References
5: Normal Radiographic Anatomy of Anterior Abdominal Wall
Introduction:
Anatomy of Anterior Abdominal Wall
Muscle Layers
Blood Supply
Nerves
Lymphatics
Physiology
Important Anatomical Regions
Space of Bogros and Space of Retzius
Important Anatomical Triangles and Landmarks
Critical View of Myopectineal Orifice
Imaging
Overview
Ultrasound
Background
Technique
Visualization of Different Types of Hernias
Computer Tomography (CT)
Background
Techniques for Visualization of Different Types of Abdominal Hernias
Magnetic Resonance Imaging (MRI)
Background
Technique for Abdominal Wall Visualization
Conclusion
References
6: Normal Anatomy: Computed Tomography Scan
Introduction
Abdominal Wall Overview
Radiographic Regions
Central/Middle Abdominal Wall Region
Midline
Linea Alba/Diastasis Recti
Umbilicus and Epigastrium
Superior Region
Inferior Region
Lateral Abdominal Wall Regions
Conclusion
Suggested Reading
7: Normal Anatomy: Ultrasonography
Introduction
General Approach to Using Ultrasound
Ultrasound Anatomy: Normal Abdomen
Ultrasound Anatomy: Indirect Hernia
Ultrasound Anatomy: Direct Hernia
Ultrasound Anatomy: Femoral Hernia
Ultrasound Anatomy: Ventral Hernia
Umbilical Hernias
Epigastric and Hypogastric Hernias
Incisional Hernias
Ultrasound Anatomy: Obturator Hernia
Ultrasound Anatomy: Spigelian Hernia
Conclusion
Bibliography
8: Normal Anatomy: Magnetic Resonance Imaging
Why MR Imaging?
How Are MR Images Obtained?
MR Sequences and Protocols
MR Contrast
MR Challenges and Limitations
MR Safety and Risks
Summary
References
9: Hallmarks of Incarcerated and Strangulated Hernias
Introduction
Clinical Presentation
Radiologic Findings
Clinical Pearls/Suggested Algorithm
Conclusion
References
10: 3D Imaging of the Abdominal Wall
Introduction
3D techniques in CT imaging
Advances in CT Imaging and Computer Capacity
Classic Rendering Techniques:
Surface Rendering:
MIP Imaging:
VRT Imaging:
Cinematic Rendering
VRT and Segmentation: Editing Step by Step
Morphometrics and Quantitative 3D CT Imaging
3D Techniques in MR Imaging
Conclusion
References
11: Direct Inguinal Hernia
Introduction and Relevant Anatomy
Role of Imaging for Direct Inguinal Hernia Diagnosis
Dynamic Ultrasound
Equipment and Technique
Reporting
Interpretation of Imaging
Multidetector Computed Tomography
Technique
Interpretation of Imaging
Magnetic Resonance Imaging
Imaging After Direct Inguinal Hernia Repair and Complications
Conclusion
Further Readings
12: Indirect Inguinal Hernia
Introduction
Symptoms
Physical Exam Findings
Anatomy
Imaging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
X-ray
Treatment
Conclusion
References
13: Femoral Hernia
Introduction
Patient Selection
CT Scan Findings
Dynamic Groin Ultrasound
Clinical Pearls
Literature Review
References
Further Readings
14: Ventral Hernias
Introduction
History and Epidemiology:
Technique
Case 1
Laparoscopic Repairs
Robotic
Imaging
Postoperative Findings and Complications
Seroma
Case 2
Hematomas
Case 3
Enterotomy
Case 4
Mesh Infection
Case 5
Fistula
Case 6
Recurrence
Case 7
Conclusion
References
Untitled
15: Subxiphoid Hernia
Introduction
Patient Selection
Case examples
Small Defect After Mediastinal Tubes
Large Circular Defect After CAB
Diaphragm and Sternal Defect After Omental Flap
Midline Component of Subcostal Incision
Subxiphoid Component of Midline Incisional Hernia
Subxiphoid Component of Midline Hernia with Loss of Domain
Literature Review
Conclusion
References
16: Suprapubic Hernias
Normal Imaging
Imaging Findings in Suprapubic Hernias
Suprapubic Hernias After Pfannenstiel Incisions
Imaging in Suprapubic Hernias in the Setting of Orthopedic Implants
Suprapubic and Inguinal Hernias
Suprapubic Hernias as a Result of Other Defects
Suprapubic Hernias in the Setting of Pelvic Prosthetics
Conclusion
References
17: Flank Hernia
Introduction
Patient Selection
Ultrasound Scanning
Magnetic Resonance Imaging
Computed Tomography Scanning
Clinical Pearls
Literature Review
Conclusion
References
Further Readings
18: Parastomal Hernias
Introduction
Incidence
Challenges
Anatomy
Normal Radiographical Findings
Ileostomy and Colostomy
Urostomy
Appendicostomy
Mesentery Considerations
Classification of PH
Rubin Classification
Gil and Szcepkowski Classification
EHS Parastomal Classification
Clinical and Radiographical Significance
Location
Prolapse
Small Bowel Obstruction
Additional Radiographical Considerations for Repair
Hernia Contents
Concomitant Hernias
Previous Repairs and Mesh Complications
Radiographical Findings After PH Repair
Sugarbaker and Keyhole Repair
Retromuscular Sugarbaker Repair (Pauli Parastomal Hernia Repair)
Stapled Transabdominal Ostomy Reinforcement with Retromuscular Mesh (STORRM)
Conclusion
References
19: Radiology of the Hiatal Hernia
Radiologic Classification
Diagnostic Workup and Preoperative Imaging
Intraoperative Testing
Postoperative Imaging and Perioperative Findings
Conclusion
References
20: Lumbar Hernias
Introduction
Normal Anatomy of the Lumbar Triangles
Superior Lumbar Hernias (Grynfeltt-Lesshaft Hernias)
Inferior Lumbar Hernias (Petit’s Hernias)
Importance of the Quadratus Lumborum as a Lumbar Landmark
Details of Importance to Surgeons
Epidemiology
Radiographic Findings Suggesting a Traumatic/Incisional/Infectious Etiology
Treatment
Summary
References
21: Spigelian Hernia
Introduction
Patient Selection
Ultrasound Scanning
Clinical Pearls
Literature Review
Conclusion
References
22: Umbilical and Epigastric Hernia
Introduction
Selection Criteria
Choosing a Modality
Modality: Ultrasound
Ultrasound Anatomy of the Anterior Abdominal Wall
Technique for Clinic Use of Ultrasound
Modality: Computed Tomography
Conclusion
References
23: Thoracoabdominal Hernia
Introduction
Pathophysiology
Presentation
Radiological Assessment
Cases
References
24: Diaphragmatic Hernia
Anatomy and Embryology
Bochdalek Hernia
Morgagni Hernia
Traumatic Diaphragmatic Hernia
Hiatal and Paraesophageal Hernias
Conclusion
References
25: Obturator, Perineal, Sciatic, Internal, and Paraduodenal Hernias
Introduction
Obturator Hernias
Perineal Hernias
Sciatic Hernias
Internal Hernias
Paraduodenal Hernias
Pericecal Hernias
Foramen of Winslow Hernias
Transmesenteric, Petersen Defect, Parasigmoid, and Transomental Hernias
Conclusion
References
26: Diastasis Recti
Introduction
Anatomy of the Linea Alba
Etiology of Rectus Diastasis
Clinical Significance of Rectus Diastasis
Classification Systems of Rectus Diastasis
Beer Classification
Rath Classification
Nahas Classification
Diagnostic Imaging
Radiograph (X-Ray)
Ultrasound
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Operative Repair of Rectus Diastasis and Appearance on Imaging
Assessing Clinical Outcomes
Conclusion
References
27: Athletic Pubalgia
Introduction
Mechanism/Presentation
Diagnosis
Evaluation: Imaging Modalities
Magnetic Resonance Imaging
Osteitis Pubis
Rectus Abdominis and Adductor Pathology
Rectus Abdominis/Adductor Aponeurotic Plate Disruption
Postoperative MRI
Ultrasound
Osteitis Pubis
Rectus Abdominis-Adductor Longus Aponeurosis Injury
Sports Hernia on Dynamic Sonogram
Ultrasound-Guided Intervention
Computed Tomography Arthrography
Treatment and Outcomes
References
28: Imaging Approach to Chronic Postoperative Inguinal Pain
Introduction
Pathophysiology of CPIP
Imaging Modalities
Commonly Encountered Pathology
Recurrence
Mesh Complications
Nerve Damage
Conclusion
References
29: Therapeutic Ultrasonography: TAP Block and BOTOX, Collections, Nerve Injections
Introduction
Patient Selection
Ultrasound Scanning
Ultrasound Procedure
Botulinum Toxin (Btox) Injection: (Video 29.1)
Nerve Blocks: (Video 29.2)
Seroma
Clinical Pearls
Literature Review
Summary
References
30: Radiographic Appearance of Mesh
Introduction
Imaging Modalities in Hernia Surgery
Importance of Mesh Identification on Imaging
Recurrence
“False Recurrence”
Access
Mesh Complications
Mesh Migration/Erosion
Appearance of Mesh on Computed Tomography
Synthetic Mesh
Biologic Mesh
Bioabsorbable Mesh
Mesh Locations in Hernia Repair
Adjuncts to Mesh Identification
Tissue Distortion
Metallic Tacks/Staples
Conclusion
References
31: Acute and Chronic Postoperative Hernia Complications and Changes
Introduction
Acute Inguinal Hernia Complications
Seroma
Hematoma
Surgical Site Infections
Small Bowel Obstruction
Ischemic Orchitis
Early Recurrence
Bladder Injury
Chronic Inguinal Hernia Complications
Chronic Pain
Recurrence
Chronic Seroma
Mesh Infection and Erosion
Acute Ventral Hernia Complications|
Seroma
Hematoma
Pain
Surgical Site Infection
Small Bowel Obstruction
Bowel Injury
Chronic Ventral Hernia Complications
Chronic Pain
Seroma
Mesh Infection and Erosion
Small Bowel Obstruction
Late Recurrence
Acute Hiatal Hernia Complications
Wrap Complications
Early Recurrence
Delayed Gastric Emptying (DGE)
Seroma and Hematoma
Esophageal Perforation
Chronic Hiatal Hernia Complication
References
32: Preoperative Planning Utilizing Imaging
Inguinal Hernia: Primary Inguinal Hernia
Recommended Imaging: Ultrasound, Sometimes MRI
Inguinal Hernia: Complications, Post-inguinal Herniorrhaphy Pain, Chronic Pelvic Pain
Recommended Imaging: MRI, Sometimes CT or High-Resolution Ultrasound
Early Postoperative Complications
Critical Situations: Mesh Infection, Intestinal Obstruction
Post-Inguinal Herniorrhaphy Chronic Pain
Neuropathic Complications
Chronic Pelvic Pain
Ventral Hernia: Primary Ventral Hernia
Recommended Imaging: CT Scan, Sometimes Ultrasound
Ventral Hernia: Incisional Hernia
Recommended Imaging: CT Scan
Complications: Fluid Collections, Chronic Pain
Conclusion
References
33: Iatrogenic Abdominal Wall Injuries
Introduction
Trocar Site Injuries
Trocar Site Bleeding
Trocar Site Dehiscence
Trocar Site Hernia
Denervation Injuries
Semilunar Line Injuries
Mesh Complications
Interparietal Herniation
Conclusion
References
34: End-Stage Hernia Disease
Section 1: Introduction
Section 2: Anatomy and Function of the Abdominal Wall
Normal Anatomy of the Abdominal Wall
Evaluation of Abdominal Wall Function
Abdominal Wall Strength (AWS) and Incisional Hernia (IH)
Abdominal Wall Strength (AWS) Following Incisional Hernia (IH) Repair
Conclusion
Section 4: Patient-Reported Quality of Life
Hernia-Related Quality of Life Tools
Incisional Hernia (IH) Occurrence Quality of Life
Cycle of Incisional Hernia (IH) Repair and Quality of Life
End-Stage Hernia Disease Quality of Life
Conclusion
Section 2: Radiologic Imaging in IH
Obesity-Related Risk Assessment
Surgical Planning with Component Separation Techniques
Postoperative Outcome Prediction
Shortcomings
Conclusion
Section 5: Conclusion
References
Index
