Chapter 60 - Anterior abdominal wall

Abstract

The anterior abdominal wall represents a complex functional unit comprised of skin, adipose tissue, fascia, muscles and neurovascular bundles. These structures play critical roles in basic trunk motion, physiological processes (e.g. cough and Valsalva functions) and provide support and protection for the peritoneal and retroperitoneal organs of the abdomen. Operations on any of these organs, which are among the most common interventional procedures performed, generally require access through the layers of the abdominal wall. Despite these critical functions and the commonality of operations on the anterior abdominal wall, the normal, variant, abnormal and post-surgical anatomy are often misunderstood in form and function. Such misunderstandings can lead to incorrect diagnoses, defunctionalization as a result of trauma to the innervation or muscle layers and devascularization leading to necrosis. This chapter reviews the anatomy of the anterior abdominal wall and the inguinal canal with particular emphasis on myofascial anatomy and hernias that can arise as a result of anterior abdominal wall defects.