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Tissue coverage for exposed vascular reconstructions (grafts)
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kaitlyn Rountree, Vikram Reddy, Sachinder Singh Hans
The greater omentum is a double sheet of peritoneum that descends from the greater curvature of the stomach, overlying the small intestine, and then folds back on itself to fuse with the peritoneum on the anterior surface of the transverse colon. The blood supply of the omentum is from the right, left, and middle omental arteries, which originate from the right and left gastroepiploic arteries, respectively. The anterior fold of the greater omentum is supplied by the larger right omental artery, while the smaller left omental artery supplies the posterior surface. The delicate and robust network of vessels transversing the omentum allow it to be crafted into the surgeon's desired size and shape while preserving one or both of the main vascular pedicles for intra-abdominal uses.22
Peritoneal metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
The peritoneal cavity is a serous sac (or coelom) lying between the parietal and visceral peritoneum (Figure 33.1). It consists of a series of communicating potential spaces not normally seen on imaging unless distended by fluid or air. The visceral peritoneum covers the abdominal organs, and the parietal peritoneum lies against the abdominal wall and retroperitoneum, resulting in an extensive surface area as a potential site of tumour deposition. The greater omentum consists of four layers of peritoneum, two from the greater curve of the stomach and two from the transverse mesocolon, which fuse and pass anterior to the small bowel—this is often involved by metastases. The lesser omentum (or gastrohepatic ligament) joins the lesser curve of the stomach to the liver. Ligaments are peritoneal folds connecting abdominal organs. A mesentery is a peritoneal fold joining the small bowel or parts of the colon to the posterior abdominal wall and containing blood vessels, lymphatics, and nerves (3). Ligaments and mesenteries are suspended by the visceral peritoneum and so are not truly intraperitoneal (4).
Anatomy
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Reza Mirnezami, Alex H. Mirnezami
The transverse colon is completely peritonealised. It begins at the hepatic flexure and hangs downward suspended by the transverse mesocolon from the antero-inferior surface of the pancreas. It terminates at the splenic flexure in the left upper quadrant, becoming continuous with the descending colon. The splenic flexure lies higher than the hepatic flexure and is suspended from the diaphragm by the phrenico-colic ligament. The greater omentum, arising from the greater curvature of the stomach, covers the transverse colon. The inferior peritoneal coat of the omentum is adherent to the anterior surface of the transverse colon and the transverse mesocolon containing the middle colic vessels and lymphatics. These peritoneal layers can be divided so that the transverse colon and mesocolon can be freed from the omentum. The proximal two-thirds of the transverse colon are supplied by the superior mesenteric artery via the middle colic arterial arcades. The distal third is supplied by the left ascending colic branch of the inferior mesenteric artery. Veins drain correspondingly into the superior and inferior mesenteric veins (the latter draining into the splenic vein). Nerve supply to the proximal two-thirds of the transverse colon is via sympathetic and vagal nerves via the superior mesenteric plexus. The distal third is innervated by sympathetic and parasympathetic pelvic splanchnic nerves via the inferior mesenteric plexus.
Lymphadenectomy in Primary Fallopian Tube Cancer is Associated with Improved Survival
Published in Journal of Investigative Surgery, 2022
Yao Xiao, Yue-xi Liu, Ruo-nan Li, Xing Wei, Qing-miao Wang, Qiu-ying Gu, Hua Linghu
The latest guidelines for OC recommend para-aortic and pelvic lymphadenectomy for all early-stage invasive EOC. For advanced-stage patients, it should only be performed on suspicious and/or enlarged nodes and not on clinically negative nodes. However, we still suggest lymphadenectomy in all patients with PFTC if it is tolerable. Omentectomy is suggested in all newly diagnosed patients. Our results showed that most of the omentum involvement in PFTC was isolated nodules, and omentum metastasis had no significant effect on the prognosis of patients with the same FIGO stage. This led us to hypothesize that if it is necessary to reassess the value of omentectomy in PFTC. However, it is insufficient to assess the involvement of the greater omentum properly only through imaging and surgical exploration and it remains controversial to balance the pros and cons of omentectomy. This is a significant area of investigation that necessitates better evidence.
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].
Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique
Published in Renal Failure, 2021
Yun Zou, Yibo Ma, Wenying Chao, Hua Zhou, Yin Zong, Min Yang
After the PD catheter is placed in the abdominal cavity, due to the propensity of the omentum to adhere to foreign bodies, the catheter can be surrounded and obstructed by the omentum, an important cause of catheter dysfunction [13,14]. In our study, 7 patients in the conventional group and 1 patient in the modified group who were able to correct catheter migration with conservative measures, probably related to simple catheter tip migration rather than omentum wrapping. In laparoscopic and open surgery, either resection or folding and fixation of the long greater omentum is a common method to prevent omentum wrapping. These two methods are not available when using percutaneous PD catheterization. Methods to reduce omentum wrapping in percutaneous placement and whether a delay in catheter use for 10−14 days after placement can reduce the incidence of omental wrapping may be worthwhile exploring in future studies.