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Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
Various terms are used to describe parts of the peritoneum/mesentery (Figure 4.5). The small intestine mesentery is referred to as “the mesentery,” but other mesenteries of specific parts of the GI tract are named accordingly: mesoesophagus, mesogastrium, transverse and sigmoid mesocolons, and mesoappendix. Omentum describes a double-layered extension of peritoneum passing from the stomach and proximal duodenum to adjacent organs. The greater omentum descends from the greater curvature of the stomach and then ascends to the anterior transverse colon and mesocolon. Similarly, the lesser omentum extends from the lesser curvature of the stomach and duodenum to the liver. Peritoneal ligaments are named based on which organs or parts of the abdominal wall they connect: falciform ligament, hepatogastric, hepatoduodenal ligament (thickened free edge of the lesser omentum conducting the portal triad), gastrophrenic ligament, gastrosplenic ligament, and gastrocolic ligament.
Laparoscopic extended right hemicolectomy and transverse colectomy
Published in Mark Coleman, Tom Cecil, Brian Dunkin, Laparoscopic Colorectal Surgery, 2017
Irshad Shaikh, John T. Jenkins
Supra-colic dissection: The transverse colon is then pulled towards the pelvis, and the omentum is elevated by an assistant to permit freeing of the colon from the omentum. For this manoeuvre to be successful, the assistant’s grasper elevates the omentum and the surgeon’s grasper pulls the transverse colon via an appendix epiploica inferiorly, to otherwise avoid tearing on the colonic serosa or mesentery. For extended right hemicolectomy, the omentum will be dissected entirely free from the colon between the flexures unless it is directly involved with malignancy. The gastrocolic ligament is identified and is retracted by the assistant inferior to the gastroepiploic artery, as it meets the greater curve of the stomach. The assistant’s grasper protects the gastroepiploic artery by providing traction adjacent to the vessel. The surgeon then enters the lesser sac and the previous infracolic dissection will become apparent. This plane is further developed on either side, and dissection to the patient’s left in this plane facilitates eventual splenic flexure mobilisation.
Right Hemicolectomy - Hand-Assisted Laparoscopic Surgery
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The surgical dissection described is unique and proceeds in a counterclockwise, top-down, fashion beginning at the gastrocolic ligament. The authors recognize advantages and disadvantages to each right colectomy technique, and we would propose that among the strengths of this particular approach are the superior exposure and visualization of the middle colic vessels and the duodenum, both of which are critical anatomic elements of right colectomy.
Does transverse colon cancer spread to the extramesocolic lymph node stations?
Published in Acta Chirurgica Belgica, 2021
Bulent C. Yuksel, Sadettin ER, Erdinç Çetinkaya, Ahmet Keşşaf Aşlar
In relation to how extramesacolic lymph node metastasis occurs, in a cadaver study, Stelzner et al. [12] stated that the transverse colon originating from the midgut and hindgut, and the gastrocolic ligament, omentum and pancreas originating from the foregut were topographically intertwined. Although the greater omentum was fully separable from the transverse colon and mesocolon, the authors showed that in hepatic and splenic flexures, the small vessels in-between formed a connection between the foregut and the midgut and hindgut. These connections provide blood flow and lymphatic flow to the lymph nodes, thus allowing the tumor cells to pass between the planes. Perrakis et al. clinically demonstrated this condition. In their study of 45 patients, the authors found extramesacolic metastatic lymph nodes in the gastroepiploic and infrapyloric areas in four patients, indicating that this transition was due to a direct connection between the right gastroepiploic artery and the omentum [13]. The anatomical background of these direct lymphatic drainage pathways is that they can cause lymph node metastasis in both gastroepiploic and infrapancreatic areas in transverse colon cancers. In addition, Perrakis and Hohenberger emphasized that this metastasis could spread through the connection between the arteria pancreatica magna and arteria pancreatica transversa in the infrapanreatic area [2,13].
Surgical Management of Life Threatening Bleeding after Endoscopic Cystogastrostomy
Published in Journal of Investigative Surgery, 2018
Ashish George, Rajesh Panwar, Sujoy Pal
The abdomen was explored through an upper midline laparotomy. There was no blood in the peritoneal cavity. The gastrocolic ligament was thickened and there was no avascular plane between stomach and transverse colon. The stomach was pushed anteriorly by the large lesser sac collection. A 6–7 cm anterior gastrotomy was done after taking stay sutures (Figure 2a). The stent was visible after the anterior gastrotomy and there was a bulge in the posterior wall of stomach (Figure 2b). The lesser sac collection was entered through the posterior wall of stomach and a 6 cm cystogastrostomy was done using a 75 mm stapler (Figure 2c). The pseudocyst was filled with around 600 ml of blood clots and there was fresh blood as well. The cyst cavity was quickly evacuated after which the active spurt from the splenic artery was seen. The bleeding was first temporarily controlled using digital pressure. The splenic artery was then ligated in continuity just proximal and distal to the site of bleeding and hemostasis was secured (Figure 2d). The anterior gastrotomy was then repaired in two layers.
Efficacy of laparoscopic gastric bypass vs laparoscopic sleeve gastrectomy in treating obesity combined with type-2 diabetes
Published in British Journal of Biomedical Science, 2021
Y Yan, F Wang, H Chen, X Zhao, D Yin, Y Hui, N Ma, C Yang, Z Zheng, T Zhang, N Xu, G Wang
For the laparoscopic sleeve gastrectomy group, after general anaesthesia with tracheal intubation, patients were placed in the supine position. The 4-holes method was used to introduce the laparoscopies. Pneumoperitoneum was established using a 10-mm Veress needle (Johnson & Johnson, USA), and CO2 gas introduced at 15 mmHg. A 5-mm puncture device was placed at 5 cm from the left flat navel, a 12-mm puncture device was placed under the right central clavicle rib, and a 5-mm puncture device was placed under the xiphoid process. The gastrocolic ligament was incised at the position of 4 cm from the pylorus near the inferior margin of the great curvature of the stomach. The omentum majus was incised along the left of the great curvature of the stomach to the cardia, and the fundus of the stomach was completely disconnected. Then, the fundus of the stomach was turned to the inside, and the blood vessels behind the stomach were disconnected with an ultrasonic knife. The great curvature of the stomach and fundus of the stomach were completely disconnected. After placing a 32–36 Fr balloon gastric tube, at a distance of 4–8 cm from the upper part of the pylorus, the great curvature of the stomach was incised, the fundus of the stomach was completely removed, and the complete cardia was preserved. Then, methylene blue physiological saline was injected into the balloon gastric tube to observe whether there was any leakage. After removing the resected tissues, the abdominal cavity was flushed, a double lumen cannula was placed along the incision of the great curvature of the stomach, and the incisions were sutured. All procedures were conducted by the same team.