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Fundoplication
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Douglas C. Barnhart, Robert A. Cina
The proximal one-third to one-half of the greater curvature of the stomach is liberated from its attachment to the spleen by ligating and dividing the upper short gastric vessels in the gastrosplenic ligament. This is facilitated by retracting the fundus rightwards with a Babcock clamp (Figure 28.15a). These vessels may be divided and secured in a number of ways. In infants and small children, these may simply be electrocoagulated. In older children, these vessels can be divided with an advanced energy device or ligated.
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
Which ligament contains the splenic pedicle?Leinorenal ligament contains a splenic pedicle.Gastrosplenic ligament contains short gastric vessels.
Peritoneal metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Cancers of the stomach, colon, pancreas, liver, gallbladder, spleen, and ovary can invade directly into the adjacent ligaments and mesenteries, and then into connecting organs as well as the gastrointestinal (GI) tract and abdominal wall (5,6). Gastric cancer often spreads into the adjacent gastrohepatic ligament and then may invade into the left lobe of the liver (7). Pancreatic cancer can extend from the retroperitoneum into the hepatoduodenal ligament (which contains the bile duct, hepatic artery, and portal vein) and then into the liver (8). Tumours of the colon, stomach, and pancreas often spread through the transverse mesocolon and greater omentum and can invade the transverse colon. The right side of the transverse mesocolon forms the duodenocolic ligament, providing a direct route for extension of colon cancer from the hepatic flexure to the duodenum (9). The phrenicocolic ligament (which extends from the splenic flexure to the diaphragm) prevents extension of metastases along the left side of the greater omentum. The gastrosplenic ligament extends from the greater curve of the stomach to the spleen and can be involved by extramural spread from gastric cancer. Direct involvement of the small bowel mesentery is commonly seen in carcinoid, pancreatic, breast, and colonic metastases. Lymphoma often spreads from the retroperitoneum through the root of the small bowel mesentery to the small bowel.
Infantile Inflammatory Myofibroblastic Tumor of Spleen
Published in Fetal and Pediatric Pathology, 2022
Balamurugan Thirunavukkarasu, Pritam Singha Roy, Kirti Gupta, Aravind Sekar, Deepak Bansal
An 18-month-old girl presented with progressive abdominal distension, pallor and failure to thrive. On examination, she had firm splenomegaly 6 cm below left costal margin. Computed tomography (CT) of abdomen showed a well-defined multilolobulated enhancing mass in the gastrosplenic ligament region that measured 9 × 8×6 cm and extended from left hemidiaphragm to lower pole of spleen. It showed central hypodensity with coarse calcification (Fig. 1A). Grossly, the tumor was grayish-white, firm in consistency with calcification, and infiltrated the spleen (Fig. 1B). Microscopy showed a spindle cell tumor arranged in interlacing fascicles in a variable fibrocollagenous stroma. The tumor margins with spleen were blurred. Tumor cells diffusely extended into the splenic parenchyma (Fig. 1C). The tumor demonstrated mild to moderate pleomorphism with eosinophilic cytoplasm and conspicuous nucleoli. Many scattered plasma cells and mature lymphocytes were present in the background (Fig. 1D). Mitotic figures were occasionally identified. The cells were diffusely positive for smooth muscle actin (SMA) (Fig. 2A) while negative for S-100p, CD117 (not shown). A diagnosis of IMT was made. Workup for ALK-1 (Clone D5F3, Roche Ventana) (Fig. 2B), ROS1 (Clone SP 384, Rabbit Monoclonal Antibody, Roche Ventana) (Fig. 2C), and Epstein–Barr virus (EBV) encoded RNA by immunohistochemistry (EBER ISH) were negative (Fig. 2D). The surgical resection margins were free of tumor. Post-excision, the child is doing well with no relapse at 10 months of follow up.
Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model
Published in Journal of Investigative Surgery, 2022
José Marcus Raso Eulálio, Manoel Luiz Ferreira, Paulo César Silva, Juan Miguel Renteria, Andrei Ferreira Costa Nicolau, Thales Penna de Carvalho, Adrielle Rodas Fernandes, Julia Radicetti de Siqueira Paiva e Silva, Alberto Schanaider, José Eduardo Ferreira Manso
Through the laparoscope inserted in the midline trocar it is possible to identify the liver, the small bowel, the stomach, the spleen and the colonic segment adjacent to the greater curvature (Figure 3). The dissector in the right trocar is then inserted between the stomach and the colon. Lifting the stomach away from the colon brings up the pancreatic lobe of the pancreas and reveals the gastrosplenic ligament, an avascular semitransparent membrane. The division of the gastrosplenic ligament with scissors separates the greater curvature of the stomach from the spleen and the from the colon. After this division, the stomach can be pushed over the liver, exposing the underlying splenic lobe of the pancreas and the right kidney (Figure 4). The splenic vessels follow the upper margin of the splenic lobe within the parenchyma, from the mesentery until the hilum, and are not usually visible in most animals.
“Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery”
Published in Annals of Medicine, 2023
Cem Kaan Parsak, İlker Halvacı, Uğur Topal
The laparoscopic Nissen–Rossetti fundoplication, in turn, included fundoplication without exposure of the gastrosplenic ligament. The abdomen was accessed using 5-mm trocars, as previously described. After the crura were adequately identified, an opening was created posterior to the esophagus, allowing an easy pass for the fundus.