Lee J. Skandalakis

Surgical Embryology and Anatomy of the Pancreas

Knowledge of the surgical embryology and surgical anatomy of the pancreas is vital to the general surgeon. This article discusses the entities related to pancreatic surgery. It also highlights some common embryologic anomalies of the pancreas.

Surgical anatomy and technique

(2nd Edition) Preface. Acknowledgements. Skin, Scalp and Nail. Neck. Breast. Abdominal Wall and Hernias. Diaphragm. Esophagus. Stomach. Duodenum. Pancreas. Small Intestine. Appendix. Colon and Anorectum. Liver. Extrahepatic. Biliary Tract. Spleen. Adrenal Glands. Carpal Tunnel. Varicosities of the Lower Extremity. Laparoscopic Surgery.

Hepatic Surgery and Hepatic Surgical Anatomy: Historical Partners in Progress

Abstract. Whether for hepatic trauma or transplantation, a surgeon’s knowledge of hepatic anatomy commonly determines a patient’s outcome. The first medically relevant anatomic studies of the liver emerged with the endeavors of Herophilus and Erasistratus between 310 and 280 bc . Yet it was not until after the development of anesthesia and antisepsis that the first formal resections were performed during the late 1800s. After vascular occlusion principles had been developed as a means of successful hemorrhage control, several deliberate attempts were made to repair the liver surgically. Such efforts culminated in the work of Wendel in 1910 when he followed avascular planes during hepatectomy. The functional anatomy of surgery and surgical technique had suddenly joined in an effort to advance the practice, and eventually the efficacy of hepatic surgeons in facilitating the modern era of segmental anatomy extended hepatectomies and transplantation surgery.

OBTURATOR HERNIA: Embryology, Anatomy, and Surgical Applications

Obturator hernia is a rare clinical entity. In most cases, it produces small bowel obstruction with high morbidity and mortality. The embryology, anatomy, clinical picture, diagnosis, and surgery are presented in detail.

The Surgical Anatomy of the Spleen

The surgical embryology and anatomy of the spleen are reported with emphasis given to ligaments, blood supply, and segmentation. The anatomic entities involved with splenic surgery are presented. Surgical applications are emphasized. Knowledge of splenic anatomy and technique, with efforts to save the organ if possible, is paramount for good results.

Tribute to a Triad: History of Splenic Anatomy, Physiology, and Surgery—Part 2

By the early 1900s it was widely accepted that the efforts of Wells, Bryant, Kaznelson, and Micheli necessitated a surgical appreciation of the pathophysiologic activities of the spleen. The respect bestowed on the diseased spleen, however, did not cohere to its healthy prototype. What else could explain Du Bois-Reymond’s telling statement of the late 1800s: “Now we come to the spleen, of it we know nothing. So much for the spleen” [1]. The essential question remained: “Este igitur splenatam necessarius?” The answer continued to be “no” well into the twentieth century. Despite Du Bois-Reymond’s sentiments, this resounding “no” did not indicate a lack of physiologic knowledge. Sir William Osler once commented, “Of the physiology of the spleen we know really very little.” To this, he quickly added, “That it is concerned with the process of blood scavenging; that it acts as a sort of warehouse for blood pigments; and that its structure in parts indicates hematopoiesis—these are about the only functions which are recognized” [2]. In 1928 William Mayo added his opinions on the topic while imparting an immunologic role to the spleen as well. He wrote:

Embryologic And Anatomic Basis Of Inguinal Herniorrhaphy

The embryology and surgical anatomy of the inguinal area is presented with emphasis on embryologic and anatomic entities related to surgery. We have presented the factors, such as patent processus vaginalis and defective posterior wall of the inguinal canal, that may be responsible for the genesis of congenital inguinofemoral herniation. These, together with impaired collagen synthesis and trauma, are responsible for the formation of the acquired inguinofemoral hernia. Still, we do not have all the answers for an ideal repair. Despite the latest successes in repair, we, to paraphrase Ritsos, are awaiting the triumphant return of Theseus.

Abdominal Wall and Hernias

The anterior abdominal wall may be considered to have two parts: an anterolateral portion composed of the external oblique, internal oblique, and transversus abdominis muscles; and a midline portion composed of the rectus abdominis and pyramidalis muscles.

The Surgical Anatomy and Technique of the Thoracoabdominal Incision

The thoracoabdominal incision provides excellent exposure of the thoracic, abdominal, and retroperitoneal compartments and can be safely performed in the vast majority of cases. To be more specific, the advantage of the left thoracoabdominal incision is excellent exposure of the lower esophagus, the gastroesophageal junction, the gastric cardia and stomach in toto, the left hemidiaphragm, the distal pancreas and spleen, the left kidney and adrenal gland, and the aorta. The advantage of the right thoracoabdominal incision is excellent exposure of the upper esophagus, the liver, the hepatic triad and inferior vena cava, the proximal pancreas, the right hemidiaphragm, the right kidney, and the adrenal gland. Several possible disadvantages should also be taken into consideration when contemplating this procedure. Morbidity and mortality may be increased with the opening of the two cavities. The surgeon must possess good detailed anatomic technique for opening and closure. This procedure is not advisable for children; it should be used only for good technical indications. Some of the more commonly encountered anatomic complications to be avoided include (1) splenic injury, occurring most often during division and resection of the diaphragm; (2) phrenic nerve injury, with subsequent diaphragmatic dysfunction; (3) ureteric injury during retroperitoneal dissection; (4) left first lumbar vein injury (located in the posterior aspect of the left renal vein) during left kidney mobilization; and (5) pain in the early postoperative period, which can occur secondary to transection of the cartilaginous costal arch. This may be minimized by secure fixation using No. 1 Prolene. Patients occasionally complain of a clicking sensation owing to nonunion of the costal cartilage.

The embryology of the inguinofemoral area: an overview

SummaryThis paper is an essay to understand the formation of the inguinal and femoral areas by means of an overview of the embryogenesis of the anterior abdominal wall below the umbilicus, as well as by examining the genesis and the descent of the gonads.Developmental considerations of the femoral canal lead to a discussion of the potential explanations for the developmental formation of a femoral hernia sac. The main argument against the congenital origin of femoral hernia is its rarity in infants and children. Despite the lack of irrevocable proof of a developmental defect, femoral hernias do occur in children and they can become strangulated. Some attractive embryological theories which attempt to explain this fact are discussed.