Anat Cell Biol.  2024 Sep;57(3):363-369. 10.5115/acb.23.305.

Surgical anatomy of transversus abdominis muscle for transversus abdominis release

• Shanthi P
• Sam F
• Jacob J
• S BR
• Rabi S

• KMID: 2559749
• DOI: http://doi.org/10.5115/acb.23.305

Abstract

Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the medial margin of muscular part of transversus abdominis (TA) is of great importance. Hence, the authors sought to describe the extent of medial margin of TA muscle. The surgical steps of TAR were performed in 10 formalin-fixed cadavers and distance between medial margin of TA muscle, lateral margin of rectus abdominis, to linea alba at five anatomical levels were documented respectively. The distance between the inferior epigastric vessels and the medial border of TA muscle was also noted. The TA muscle was within the posterior rectus sheath in all cadavers, at the xiphisternum (R, 61.6 mm; L, 58.9 mm), and at midway between xiphisternum and umbilicus (R, 25.4 mm; L, 27.1 mm). The TA muscle exited the posterior rectus sheath between this point and the umbilicus. The mean incongruity at the next three levels were –24.6 mm, –24.9 mm, and –22.9 mm respectively on the right and –21.4 mm, –19.9 mm, and –18.9 mm respectively on the left. The mean distance between the medial border of TA and inferior epigastric vessels was 18.9 mm on the right and 17.2 mm on the left. The muscular part of TA was incorporated within the posterior rectus sheath above the umbilicus, and it completely exited the rectus sheath at the umbilicus. This is contrary to the traditional understanding of posterior rectus sheath formation.

Keyword

Rectus abdominis; Epigastric; Transversus abdominis; Linea alba; Umbilicus

Figure

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  Fig. 1 (A) Anterior view of the anterior abdominal wall, showing transversus abdominis release procedure on a cadaver. Black asterisk, posterior rectus sheath; blue asterisk, fascia transversalis (plane developed beneath the transversus abdominis); green pins, arcuate line. (B) Showing the lateral view of the anterior abdominal wall, yellow arrow pointing at the neurovascular structures piercing the posterior rectus sheath.

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  Fig. 2 Schematic diagram showing the measurements of transversus abdominis muscle. TT’, medial margin of transversus abdominis muscle; RR’, lateral margin of rectus abdominis; dotted line, arcuate line; measurements were taken at (a) the level of xiphisternum; (b) the midway between xiphisternum and umbilicus; (c) the level of umbilicus; (d) the level of arcuate line; (e) the midway between arcuate line and pubic symphysis.

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  Fig. 3 Depiction of the outlines of the medial margin of transversus abdominis muscle (TT’, red line); lateral margin of rectus abdominis muscle (RR’, blue line); LL’, linea alba; RL, distance between lateral margin of rectus abdominis and linea alba; TL, distance between the medial margin of transversus abdominis and linea alba. The black dotted lines represent the mean TA distance (RL–TL) at various levels (a, xiphisternum; b, midway between xiphisternum and umbilicus; c, umbilicus; d, arcuate line; e, midway between arcuate line and pubic symphysis). The positive distances indicate overlap and negative distances indicate lack of overlap. The distances in mm are converted to cm for the sake of ease and clarity.

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  Fig. 4 Dissection of anterior abdominal wall demonstrating the rectus abdominis muscle, transversus abdominis (TA), and posterior layer of rectus sheath (A, B). Measurements were taken at (a) xiphisternum, (b) midway between xiphisternum and umbilicus, (c) umbilicus, (d) arcuate line, and (e) midway between arcuate line and pubic symphysis. Dotted line indicates linea alba. Note that the TA completely exits the posterior rectus sheath at the level of umbilicus.

Reference

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