Surgical anatomy and morphologic variations of umbilical structures
Amir H Fathi1, Hooman Soltanian, Alan A Saber
1Department of General Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio 44106, USA.
The American Surgeon
|May 2, 2012
Summary
This study reveals that the umbilical fascia and round ligament attachment are crucial protective factors against umbilical hernias. Their absence in cadavers correlated with hernia presence, highlighting their importance in abdominal wall integrity.
Area of Science:
- Anatomy
- Surgical Anatomy
- Hernia Research
Background:
- The umbilicus serves as a key entry point for laparoscopic surgery.
- Umbilical anatomy is underrepresented in surgical and anatomical literature.
- Increasing use of single-site surgery and high incidence of umbilical hernias necessitate detailed anatomical study.
Purpose of the Study:
- To comprehensively investigate umbilical structures.
- To analyze the protective role of umbilical anatomy against hernias.
- To classify umbilical ring morphology and ligamentous attachments.
Main Methods:
- Dissection and measurement of umbilical structures in 24 embalmed cadavers.
- Analysis included round hepatic, median, and medial ligaments, umbilical ring, umbilical and umbilicovesicular fasciae.
- Cadavers were aged adults (mean 82.1 years), predominantly white males.
Main Results:
- Umbilical ring morphology and ligament attachment patterns were classified into five types.
- A 25% incidence of umbilical hernias was observed.
- Hernia cases consistently lacked umbilical fascia and had absent round hepatic ligament attachment to the inferior umbilical ring border.
Conclusions:
- The umbilical fascia is proposed as a condensation of the umbilicovesicular fascia, not transversalis fascia.
- The umbilical fascia and round ligament's inferior border attachment are significant protective mechanisms against umbilical hernias.
- Absence of these two features was a consistent finding in all observed umbilical hernias.
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