Anatomical variations of the pyramidalis muscle: a systematic review and meta-analysis
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ANATOMIC VARIATIONS
Anatomical variations of the pyramidalis muscle: a systematic review and meta‑analysis Roberto Cirocchi1 · Isaac Cheruiyot2,3 · Brandon Michael Henry2,4 · Marco Artico5 · Sara Gioia1 · Piergaspare Palumbo6 · Vincent Kipkorir2 · Vito D’Andrea6 · Justus Randolph7 Received: 26 September 2020 / Accepted: 10 November 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose To provide a comprehensive evidence-based assessment of the anatomical characteristics of the pyramidalis muscle (PM). Materials and methods A thorough systematic search of the literature through August 31st 2020 was conducted on major electronic databases PubMed, Scopus and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaFor package in R and MetaXL. A random-effects model was applied. The primary outcome of interest was the prevalence of PM. The secondary outcomes were the dimensions (length and width) of the PM. Results A total of 11 studies (n = 787 patients; 1548 sides) were included in the meta-analysis. The multinomial pooled prevalence estimate (PPE) for a bilateral absence of the PM was 11.3% (95% CI [7.2%, 16.2%], 82.3% (95% CI [76.2%, 87.6%]) for a bilateral presence, and 6.3% (95% CI [3.3%, 10.2%]) for a unilateral presence. Of four studies (n = 37 patients) that reported the side of a unilateral presence, the PPE of a unilateral right-side presence was 42.2% (95% CI [23.0%, 62.3%]) compared to 57.8% for a unilateral left-side presence (95% CI [37.7%, 77.0%]). The mean length of the PM displayed high levels of heterogeneity, ranging from 3.12 to 12.50 cm. Conclusion The pyramidalis muscle is a rather constant anatomical structure being present in approximately 90% of individuals. Keywords Pyramidalis muscle · Anatomical variations · Morphometry
Introduction * Isaac Cheruiyot [email protected] 1
Department of Surgical Science, University of Perugia, Piazza dell’Universitá, 1, 06123 Perugia, PG, Italy
2
Department of Human Anatomy, University of Nairobi, P.O. Box 30197, 00100 Nairobi, Kenya
3
International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31‑034 Krakow, Poland
4
Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
5
Department of Human Anatomy, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, RM, Italy
6
Department of General Surgery, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, RM, Italy
7
Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA
The pyramidalis muscle (PM) is a small triangular muscle located in the lower part of the anterior abdominal wall, between the anterior surface of the rectus abdominis muscle (RAM) and the posterior surface of the anterior layer of the rectus sheath (RS) [16, 18, 33]. It is attached by tendinous fibers to the front of the pubis and to the ligamentous fibers in front of the symphysis. The muscle diminis
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