Topography of the Inferior Epigastric Artery in Relation to Laparoscopic Surgery

Praisy Joy, R (2014) Topography of the Inferior Epigastric Artery in Relation to Laparoscopic Surgery. Masters thesis, Christian Medical College, Vellore.

[img]
Preview
Text
202301114praisy_joy.pdf

Download (3MB) | Preview

Abstract

INTRODUCTION: The inferior epigastric artery is a major blood vessel that supplies the anterior abdominal wall. It commonly arises from the external iliac artery, proximal to the attachment of inguinal ligament. The inferior epigastric artery (IEA) raises a fold of parietal peritoneum called as the lateral umbilical ligament. Injury to the artery by surgical incisions, example for laparoscopic ports, is common and the resulting hematoma may expand considerably due to lack of tissue against which the bleeding can be effectively compressed. The artery then ascends on the anterior abdominal wall, and after piercing the transversalis fascia it lies between the rectus abdominis and the fascia. The inferior epigastric artery lies medial to the deep inguinal ring. Here the vas deferens or the round ligament winds around it laterally in the male or female respectively. The IEA divides into numerous branches which anastomose with branches of the superior epigastric artery. The inferior epigastric artery is usually larger than the superior epigastric artery and provides the main supply to the rectus muscle. The artery has the following branches: the cremasteric artery, pubic branch, muscular branches and cutaneous branches. OBJECTIVES: To study the inferior epigastric artery in relation to certain anatomical landmarks in cadavers and CT angiograms and suggest suitable sites for safe trocar placement in laparoscopic surgery. METHODS: Thirty cadavers and fifty CT angiograms were studied to determine the distance of the inferior epigastric artery (IEA) and the lateral border of rectus abdominis from the midline at three levels which are the mid-inguinal point, ASIS and umbilicus. These measurements were compared among males and females using Mann Whitney test and between sides using the independent sample t-test. Comparison between cadavers and CT angiograms was performed using the independent sample t-test. The branches of the IEA > 1mm were studied in cadavers. RESULTS: The ASIS is an abdominal landmark apparent at laparoscopy. IEA has a constant relation with the ASIS. The mean distance of the IEA from the midline was 4.10 ± 0.82cm in cadavers and 4.57 ±1.05cm in CT angiograms at the level of ASIS. Insertion of primary trocars in the midline and secondary trocars at a distance >6 cm from the midline, both at the level of ASIS is suggested to avoid injury to IEA. The branches are least found in the lowest part of the abdomen lateral to the artery. CONCLUSIONS: 1. The mean distance of the lateral border of rectus abdominis from the midline was 5.32 ±1.15cm at the level of mid-inguinal point, 5.95 ± 1.20cm at the level of ASIS and 6.68 ±1.13cm at the level of umbilicus in cadavers. 2. The mean distance of the inferior epigastric artery from the midline was 4.45 ±1.08cm at the level of mid-inguinal point, 4.10 ± 0.82cm at the level of ASIS and 4.54 ±1.04cm at the level of umbilicus in cadavers. 3. The mean distance of the lateral border of rectus abdominis from the midline was 5.55 ± 1.15cm at the level of mid-inguinal point, 6.81 ± 1.16cm at the level of ASIS, and 8.40 ± 1.37cm at the level of umbilicus in CT angiograms. 4. The mean distance of the inferior epigastric artery from the midline was 5.17 ±0.93cm at the level of mid-inguinal point, 4.57 ±1.05cm at the level of ASIS, and 5.27 ±1.17cm at the level of umbilicus in CT angiograms. 5. There was a definite predictive pattern in the course of the inferior epigastric artery as seen in correlation and regression analysis. 6. On comparing the measurements between male and female cadavers, it was found that the measurements of rectus abdominis (ratios) were more in males than in females at the ASIS (p < 0.05) and umbilicus (p < 0.01). 7. There was no gender difference on comparing the measurements in the CT angiograms of males and females. 8. The right side inferior epigastric artery was seen to be more laterally placed than the left side artery in cadavers. 9. In CT angiograms, right side inferior epigastric artery was seen to be more laterally placed than the left side artery at the level of mid-inguinal point and umbilicus. 10. In 70% of cadavers, the IEA had a single trunk and in 30% had two trunks. 11. The branches of IEA in the lower third of the infraumbilical part of the anterior abdominal wall were 37 branches on the lateral side and 44 branches on the medial side of the artery. In the upper two-thirds, 79 branches were found on the lateral side of the artery and 25 branches medial to it. 12. Ports for primary trocar insertion could be at the umbilicus if using the Hasson technique. A Veress needle can also be inserted safely in the midline at the level of ASIS. 13. Ports for secondary trocar insertion should be along the lateral border of rectus abdominis. The trocars should be placed more than 6 cm from the midline slightly superior to ASIS and more than 9 cm at the level of umbilicus from the midline for laparoscopic surgeries.

Item Type: Thesis (Masters)
Additional Information: Reg.No.20117162
Uncontrolled Keywords: Inferior epigastric artery, laparoscopic surgery, hemorrhage, rectus abdominis, anterior abdominal wall.
Subjects: MEDICAL > Anatomy
Depositing User: Subramani R
Date Deposited: 09 Jul 2020 08:23
Last Modified: 09 Jul 2020 08:26
URI: http://repository-tnmgrmu.ac.in/id/eprint/12511

Actions (login required)

View Item View Item