Yeray Trujillo Loli is a General Surgeon from the Universidad Nacional Mayor de San Marcos, Master in Endoscopic Surgical Techniques at the Universidad Autónoma de Barcelona, Fellowship in Hepatobiliopancreatic Surgery and Gastrointestinal Surgery at the Hospital Clínic de Barcelona. Currently working as a General Surgeon at the National Hospital Daniel Alcides Carrion and as an associate professor of Human Anatomy at the Universidad Nacional Mayor de San Marcos, AIS CHANNEL Ambassador in Peru.
Selected publications from PubMed
What you don’t dare to ask about the surgical anatomy of the Abdominal Wall. – What’s the Arcuate line (of Douglas) and what structures does it separate? – What’s the Myopectineal Orifice (of Fruchaud) and what are its boundaries? – What’s the triangle of Doom and what is its surgical relevance? TO ANSWER THE QUESTIONS What’s the Arcuate line (of Douglas) and what structures does it separate? – It’s a horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath – It’s located about halfway from the umbilicus to the pubic crest – Superior to the arcuate line, the internal oblique aponeurosis splits to envelop the rectus abdominis muscle both anteriorly and posteriorly. – Inferior to the arcuate line, the internal oblique and transversus abdominis aponeuroses merge and pass superficial (i.e. anteriorly) to the rectus muscle. What’s Fruchaud’s Myopectineal Orifice? – It’s a distinct area of weakness in the inguinal region – It’s composed by two regions separated by the inguinal ligament; the suprainguinal region site for direct and indirect inguinal hernias, and a small subsegment of the subinguinal region, site for femoral hernias. – Its boundaries are as follows: . Superior: Arch of the internal oblique muscle and the transversus abdominis muscle . Lateral: Iliopsoas muscle . Medial: Lateral edge of rectus abdominis muscle . Inferior: Pubic pecten What’s the Triangle of Doom? – It’s a danger area located formed by the gonadal vessels laterally and the ductus deferens medially. These anatomic entities meet at the deep inguinal ring – Within this triangle are external iliac vessels – The point to be remembered is that the mesh, that we used in hernioplasty, should not be fixed in this region to avoid “doom” bleeding complications.
Published
Jan 2021
How is the rectum/anus complex irrigated? What is the composition of the venous drainage of the rectum/anus complex? How is the rectum/anus complex innervated? To answer the questions: HOW IS THE RECTUM/ANUS COMPLEX IRRIGATED? The arterial irrigation of the rectum anus complex has 4 pedicles: Superior Rectal Middle Rectal Inferior Rectal Median Sacral It is important to remember that not all branches are constant WHAT IS THE COMPOSITION OF THE VENOUS DRAINAGE OF THE RECTUM/ANUS COMPLEX? The venous drainage of the rectum anus is composed of 3 plexuses. Internal venous plexus Perimuscular venous plexus External venous plexus There is communication between the different venous plexuses. It is important to remember that the first plexus drains into the portal system and the last two into the inferior vena cava system. HOW IS THE RECTUM/ANUS COMPLEX INNERVATED? The rectum/anus complex is innervated by fibers originating in the superior and inferior hypogastric plexus, all of them arriving at the Lee Frankenhausen ganglia, which give off multiple branches. One of them is the rectal branch. The innervation of the rectum anus consists of 2 components: The Sympathetic component is responsible for inhibiting rectal peristalsis and stimulates the internal anal sphincter. The Parasympathetic component is responsible for stimulating the rectal peristalsis (defecation) and inhibits the internal anal sphincter.
Published
Oct 2020
What you were afraid to ask about splanchnic innervation: - How is splanchnic innervation structured? - How is the solar plexus structured ? - How are the hypogastric plexuses structured? To answer the questions How is splanchnic innervation structured? · Abdominopelvic structures are innervated by the autonomic nervous system. · Sympathetic and parasympathetic components from different branches form a nervous network, originating 3 different plexus: · Celiac [solar] plexus · Superior hypogastric plexus · Inferior hypogastric[pelvic] plexus · This maintains the normal function of the different organs, regulating their activity. How is the solar plexus structured? · The solar plexus is structured into: ganglia, afferences and efferences. · The various branches merge their fibers, yielding as many branches as the abdominal aorta has. · It innervates almost all the abdominal viscera How are the hypogastric plexuses structured? · There are 2 hypogastric plexuses: superior and inferior · The superior hypogastric nerve carries autonomic fiber towards the inferior hypogastric plexus. · The inferior hypogastric plexus has many visceral functions.
Published
Jul 2020
What you are too afraid to ask about surgical anatomy of the stomach What is the criminal nerve of Grassi? What are the Lymph node stations of the stomach? How is the cardia irrigated? To answer the questions: What is the criminal nerve of Grassi? It is the first branch of the posterior vagus nerve that gives innervation to the posterior wall of the gastric fundus. What are the lymph node stations of the stomach?Lymph node stations are described in this class: there are 20 groups in the abdominal area that are divided into regional lymph nodes and metastatic lymph nodes, and 3 groups in the thoracic region (110, 111 and 112). How is the cardia irrigated?The cardia is irrigated by the anterior and posterior cardioesophageal arteries (also called anterior and posterior gastric arteries) and by branches of the lower diaphragmatic artery.
Published
Apr 2020
WHAT ARE YOU AFRAID TO ASK ABOUT SURGICAL TECHNIQUE? How do you make surgical knots correctly? Is it OK to make every knot in the same direction? Is it OK to cross the edges of the suture to make the knot? To answer these questions you must know about types of basic knots, knot combinations, knot symmetry, blocking sequences. The half knot is made by crossing the two ends over each other in the horizontal plane and pulling both ends in opposite directions. This is called “H”. In the half hitch, either thread plays a different role. One remains inactive (blue), and the other one, which is called the active (purple) thread, makes the knot by wrapping itself around the other thread and pulling it in an angle of 90º. This is called “S”. The horizontal combinations of the half knot are: H1, H2 and H3. They are made when the suture is given one, two or three horizontal twists. DANGER KNOT: the knot opens at 0 Newton of force. SAFE KNOT: the knot has a correct blocking sequence. TO ANSWER THE QUESTIONS How do you make a good knot? By making half knots or half hitches using correct combinations and blocking sequences. Is it ok to make every knot in the same direction? Half-hitch sequences can be made in the same direction (with the lap of the needle holder around the suture). However, you should change the direction of the suture threads (90º) to make a correct blocking sequence. Half knot sequences can be made in the same direction only when you make square knots and suture threads are pulled in opposite direction (180º) To finish: if you make half-hitches, you should always make a blocking half hitch at the end. If you make half knots, make sure that they are all square knots. When you pull the suture threads to adjust the knot, do you have to cross them? If you make half hitches, it is not necessary to cross the threads. If you make half knots, you MUST cross the suture threads to make a correct square knot. The shorter thread should always be on the same side as the hand that is making the knot.
Published
Nov 2019
EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT SURGICAL TECHNIQUE Are any knots stronger than others? Is it incorrect to cross hands or surgical instruments when you make a knot? Is there any way to correct a weak knot? To answer these questions you must know a vertical combination of half knots, vertical combinations of half hitches, monomanual knotting technique, and bimanual knotting technique. TO ANSWER THE QUESTIONS Are any knots stronger than others? The strongest knots are the sequences: H3H2 (a, s) and H2H2 (a, s) Other safe combinations are“H2” + “H1s”, followed by 2 blocking half hitches or sequences of 5 half hitches with 3 blocking sequences. The weakest combination is H2H1s, even after 1 or 2 additional H1 half knots. Is it incorrect to cross the hands or needle holders when you make a knot? It is incorrect if you only use a bimanual technique, but if you use a monomanual knotting technique you always have to cross hands or instruments. Is there any way to correct a weak knot? If there is any doubt about the quality of the knot, you can make a final sequence: SSb (half hitch-blocking half hitch), but the quality of the knot will not be the same as that of a correct sequence.
Published
Sep 2019
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