Functional Ct in Laparoendoscopic Abdominal Wall Surgery. Key Points and Surgical Application

Background At present the abdominal wall hernia treatmen is clearly trending towards less invasive techniques and we believe the functional CT scan offers great value information for patient selection as well as for surgical planning. We descibe de image key points and landmarks we use to design the best surgical. Method After 5 years performing eTEP Rives-Stoppa for ventral hernia sugery, we describe the secuential standardized steps we use to evaluate a functional Ctscan to plan the surgical approach. A CT scan, without any oral or intravenous contrast, combining Valsalva maneouver images along with negative pressure will provide the best information of the dynamic behaviour of the abdominal wall. The preoperative study of the volumetric and anatomical landmarks will guide us to tailor surgery. Defect measures: Wide Location Volumen Content Previous mesh, fixation devices placement. Undiagnosed diseases. Anatomic key points Anatomic landmarks Diastasis Abdominal rectus wide Muscular atrophy Distance to: Pubis Xifoid Subcostal margin Semilunar line Quadratus lumborum muscle Results Preoperative study of the volumetric and anatomical landmarks will guide us to design our surgical strategy: Need for surgical prehabilitation. Patient position. Number and port placement. Spaces we need to approach (retrorectal, pretransversalis, preperitoneal) to repair the defect and deploy the mesh with enough overlap. Need to perform a TAR. Conclusion Functional CTscan provides us basic information of the patient’s abdominal wall. Thorough anamnesis and physical examination combined with this image test will help us render the best surgical repair.