Anterior/posterior fascia in the abdomen???

[brulaz]

Hello everyone, just wanted to ask you guys 2 questions.

1) This week, my resident was teaching me about the use of Veress needle to establish pneumoperitoneum during laparoscopic cases. He mentionned that one should hear 3 clicks as the needle advances: anterior fascia, posterior fascia and peritoneum.

I was too ashamed to ask but what are the anterior and posterior fascia? It can't be the same as the anterior and posterior rectus sheath as the lap ports we did were definitely lateral to the rectus muscle. Given that the layers of the abdomen are: Skin, camper, scarpa, ext ob, int oblique, trans abdom, trans fascia, preperitoneal fat and peritoneal fat, I have trouble understanding what the ant and post fascia are.

2) Also, while creating an ileostomy, my attending was showing me the "posterior sheath". Is this the same as the posterior rectus sheath? Again, I'm pretty sure we were lateral to the rectus muscle, so I'm really not sure what he meant...

Thanks!

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[VPDcurt]

Hello everyone, just wanted to ask you guys 2 questions.

1) This week, my resident was teaching me about the use of Veress needle to establish pneumoperitoneum during laparoscopic cases. He mentionned that one should hear 3 clicks as the needle advances: anterior fascia, posterior fascia and peritoneum.

I was too ashamed to ask but what are the anterior and posterior fascia? It can't be the same as the anterior and posterior rectus sheath as the lap ports we did were definitely lateral to the rectus muscle. Given that the layers of the abdomen are: Skin, camper, scarpa, ext ob, int oblique, trans abdom, trans fascia, preperitoneal fat and peritoneal fat, I have trouble understanding what the ant and post fascia are.

2) Also, while creating an ileostomy, my attending was showing me the "posterior sheath". Is this the same as the posterior rectus sheath? Again, I'm pretty sure we were lateral to the rectus muscle, so I'm really not sure what he meant...

Thanks!

Yes both are talking about the sheath/fascia. I sure hope you weren't placing an ileostomy lateral to the rectus muscle!

 

[Slack3r]

Hello everyone, just wanted to ask you guys 2 questions.

1) This week, my resident was teaching me about the use of Veress needle to establish pneumoperitoneum during laparoscopic cases. He mentionned that one should hear 3 clicks as the needle advances: anterior fascia, posterior fascia and peritoneum.

I was too ashamed to ask but what are the anterior and posterior fascia? It can't be the same as the anterior and posterior rectus sheath as the lap ports we did were definitely lateral to the rectus muscle. Given that the layers of the abdomen are: Skin, camper, scarpa, ext ob, int oblique, trans abdom, trans fascia, preperitoneal fat and peritoneal fat, I have trouble understanding what the ant and post fascia are.

2) Also, while creating an ileostomy, my attending was showing me the "posterior sheath". Is this the same as the posterior rectus sheath? Again, I'm pretty sure we were lateral to the rectus muscle, so I'm really not sure what he meant...

Thanks!

In the future, asking for a quick clarification shouldn't cause you any shame. When in doubt ask. Better to look stupid than pretend you know and cause harm down the road.

 

[CaptainSSO]

In the future, asking for a quick clarification shouldn't cause you any shame. When in doubt ask. Better to look stupid than pretend you know and cause harm down the road.

Not necessarily. Often it's better to keep your mouth shut and be thought a fool rather than open it and remove all doubt, as Mark Twain said.

 

[Dr.LeoSpaceman]

Hello everyone, just wanted to ask you guys 2 questions.

1) This week, my resident was teaching me about the use of Veress needle to establish pneumoperitoneum during laparoscopic cases. He mentionned that one should hear 3 clicks as the needle advances: anterior fascia, posterior fascia and peritoneum.

You shouldn't be ashamed considering you were given inaccurate information. Traditionally it's known as the "Double Click" test...not triple click. One click for the fascia/muscle and one for the peritoneum. And while people use it, it's not perfect. You can hear 2 clicks and not be in, or hear 2 clicks and be inside the lumen of the bowel. You might hear 1 (or 0) clicks but be in. To use the Veress safely, you can't (and shouldn't) depend on any one sign.

 

[dpmd]

I just dictate that I heard "the characteristic clicks" and leave it at that. Could be one, could be two. Can't say I ever heard 3 even when entering LUQ but technically I guess it would be accurate. As for the OP, rectus is wider than many people think.