Twelfth rib resection: a direct posterior surgical approach for subphrenic abscesses

Ant Waist Surgery: Aesthetic Removal of Floating Ribs to Decrease the Waist-hip Ratio

Decreasing waist circumference has become an essential feature in modern body contouring surgery owing to the attractiveness of hourglass body shapes. Traditionally, this can be achieved through lipomodeling and abdominal musculature strengthening techniques. An adjunctive procedure for ideal shaping of the waistline is resection of the 11th and 12th ribs, referred to as floating ribs. This study aimed to report and analyze clinical outcomes and self-reported patient satisfaction after "ant waist" surgery (floating rib removal) for aesthetic reasons. We retrospectively reviewed the medical records of five patients who had undergone bilateral 11th and 12th rib resections at a single institute in Taiwan in an outpatient setting. The mean lengths of the resected left and right 11th ribs were 9.1 and 9.5 cm, respectively. The mean lengths of the resected left and right 12th ribs were 6.3 and 6.4 cm, respectively. The mean waist-to-hip ratio decreased from 0.78 preoperatively to 0.72 postoperatively, with a mean decrease of 7.7%. No adverse events were reported. Generally, all patients reported being satisfied with the operation. Floating rib resection proved useful and effective in decreasing the waist-to-hip ratio using a safe, simple, and reproducible technique without significant complications. Although preliminarily, the authors' comprehensive demonstration of this ant waist surgery supports further studies focusing on waistline contouring.

Aesthetic Contouring of the Chest wall with Rib Resection

BACKGROUND

In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes.

METHODS

A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details.

CONCLUSIONS

Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sectional Anatomy of the Peritoneal Reflections of the Upper Abdomen in the Coronal Plane

PURPOSE

The purpose of this study was to provide practical anatomic data for the imaging diagnosis and surgical treatment of the diseases of the subphrenic spaces.

METHODS

The sectional anatomy of the subphrenic spaces on the coronal plane was investigated on serial coronal sections of the upper abdomen of 30 Chinese adult cadavers.

RESULTS

The space between the anterior margin of gastropancreatic fold and the posterior layer of hepatogastric ligament is the only direct pathway between the superior and inferior recesses of the lesser sac. That pathway can be divided into 3 types on the coronal plane. The right layer of the gastrophrenic ligament is continuous with the posterior layer of the lesser omentum, and its left layer is continuous with the right layer of the phrenosplenic ligament and the posterior layer of the gastrosplenic ligament. The gastropancreatic fold is continued to the left and right layers of the gastrophrenic ligament upwards. The bare area of the stomach is located between the left and right layers of the gastrophrenic ligament; its existing rate is 100%. The bare area of the spleen is located among the phrenosplenic ligament, gastrosplenic ligament, splenorenal ligament, and splenocolic ligament. Its greatest width exists between the two layers of the splenorenal ligament. It can be divided into the splenic hilus and splenorenal parts.

CONCLUSION

The coronal section is dominant to show the anatomic relationships of the gastrophrenic ligaments and the gastropancreatic folds, and the bare area of the stomach.