American Journal of Obstetrics & Gynecology
Volume 202, Issue 3 , Pages 234.e1-234.e5, March 2010

Anterior abdominal wall nerve and vessel anatomy: clinical implications for gynecologic surgery

Presented at the 29th Annual Scientific Meeting of the American Urogynecologic Society, Chicago, IL, Sept. 4-6, 2008.

  • David D. Rahn, MD

      Affiliations

    • Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • John N. Phelan, PhD

      Affiliations

    • Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Shayzreen M. Roshanravan, MD

      Affiliations

    • Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Amanda B. White, MD

      Affiliations

    • Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Marlene M. Corton, MD

      Affiliations

    • Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX

Received 7 July 2009; received in revised form 31 July 2009; accepted 27 October 2009. published online 21 December 2009.

Objective

We sought to describe relationships of clinically relevant nerves and vessels of the anterior abdominal wall.

Study Design

The ilioinguinal and iliohypogastric nerves and inferior epigastric vessels were dissected in 11 unembalmed female cadavers. Distances from surface landmarks and common incision sites were recorded. Additional surface measurements were taken in 7 other specimens with and without insufflation.

Results

The ilioinguinal nerve emerged through the internal oblique: mean (range), 2.5 (1.1–5.1) cm medial and 2.4 (0–5.3) cm inferior to the anterior superior iliac spine (ASIS). The iliohypogastric emerged 2.5 (0–4.6) cm medial and 2.0 (0–4.6) cm inferior. Inferior epigastric vessels were 3.7 (2.6–5.5) cm from midline at the level of the ASIS and always lateral to the rectus muscles at a level 2 cm superior to the pubic symphysis.

Conclusion

Risk of anterior abdominal wall nerve and vessel injury is minimized when lateral trocars are placed superior to the ASISs and >6 cm from midline and low transverse fascial incisions are not extended beyond the lateral borders of the rectus muscles.

Key words: iliohypogastric, ilioinguinal, inferior epigastric, nerve injury, vascular injury

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 Cite this article as: Rahn DD, Phelan JN, Roshanravan SM, et al. Anterior abdominal wall nerve and vessel anatomy: clinical implications for gynecologic surgery. Am J Obstet Gynecol 2010;202:234.e1-5.

 Reprints not available from the authors.

PII: S0002-9378(09)02094-8

doi:10.1016/j.ajog.2009.10.878

American Journal of Obstetrics & Gynecology
Volume 202, Issue 3 , Pages 234.e1-234.e5, March 2010

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