Fig. 3

Evolution of internal abdominal cavity perimeter during increase in volume. In case of gynoid obesity, the internal abdominal perimeter is shaped as an ellipse. Patients with an ellipse‐shaped internal perimeter have a huge stretching capacity (and thus very good abdominal compliance); this is illustrated with the progression of the shape from ellipse (dotted line) at baseline to a sphere (solid line) at very high intra-abdominal pressures (IAP) obtained during laparoscopy. The arrows show the centripetal movement of the lateral edges of the ellipse and a centrifugal movement of the cranio‐caudal edges. During increase in intra-abdominal volume (IAV) from baseline to stretched and maximal stretched IAV, the difference between the long and short axes of the ellipse decreases, while the internal perimeter and surface area increase. At maximal stretch, the external and internal abdominal perimeter are equal. Patients with android obesity do not have this reshaping and stretching capability. Adapted from [2] with permission