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Hepatic Dearterialization and Infusion Treatment of Liver Tumors
Published in Hans-Inge Peterson, Tumor Blood Circulation: Angiogenesis, Vascular Morphology and Blood Flow of Experimental and Human Tumors, 2020
Stig Bengmark, Eva Peterson-Dahl, Per E. Fredlund
Hepatic artery ligation is a relatively simple operation to perform and has been extensively used by many authors.25-35 In order to disrupt the collateral flow and improve the effectivity of the arterial occlusion, the original operative procedure was extended to include not only the distal ligation of the hepatic artery, but also a meticulous dis-section of all other structures carrying arterial collaterals to the liver. In the hepatoduodenal ligament the common duct and the portal vein were denuded and other structures ligated and divided. The falciform and triangular ligaments were divided and all connections between the diaphragm and the liver were cut. The lesser omentum was opened and branches from the phrenic arteries were sought and divided. The completeness of the procedure could be controlled by means of wash out studies after injection of radioactive Xenon. The surgical method described above has been called total or complete hepatic dearterialization, and is a far more extensive and difficult operation than simple hepatic artery ligation. For clinical purposes complete dearterialization is considerably more effective36 and several reports of this method have appeared during recent years.37-41 Many patients, though, present enormously enlarged livers and it may be practically impossible to break all collaterals. It may also be suspected that the more extensive procedure will cause a higher complication rate and the preoperative mortality has been around 20% in larger materials.37,42
Normal Gallbladder Anatomy and Imaging
Published in Jon W. Meilstrup, Imaging Atlas, 2018
Simon Westacott, Rickhesvar Mahraj
The gallbladder fossa is continuous posterosuperiorly with the porta hepatis, a transverse groove in the inferior surface of the liver traversed by the hepatic artery, portal vein, and common bile duct. A reflection of the peritoneum which covers the inferior surface of the liver forms a sleeve around these structures known as the hepatoduodenal ligament (free edge of the lesser omentum). Occasionally, a fold of peritoneum may connect the hepatoduodenal ligament to the peritoneal reflections around the gallbladder, forming the cholecystoduodenal ligament.
Surgical management of adult and pediatric renovascular hypertension
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
James C. Stanley, Jonathan L. Eliason, Dawn M. Coleman
Exposure of the hepatic artery is obtained through the lesser sac following incision of the hepatoduodenal ligament. The distal CHA, gastroduodenal, and proper hepatic arteries are dissected about their circumference and encircled with vessel loops. Following systemic anticoagulation with heparin, and arterial occlusion with Heifetz clamps, an arteriotomy is made on the inferior aspect of the distal CHA.
Internal herniation through the foramen of Winslow: a case report
Published in Acta Chirurgica Belgica, 2020
Yanina Jeanne Leona Jansen, Koenraad Nieboer, Ellie Senesael, Kobe Van Bael, Mathias Allaeys
Even though the patient was in extreme and constant pain, the physical examination was unremarkable except for a mild tenderness of the epigastrium. A blood test on admission was normal apart from an elevated white blood cell count (15.2 × 10/mm3 with neutrophilia). An abdominal X-ray demonstrated an empty left colon (Figure 1A). A contrast enhanced CT-scan showed a volvulus of a caecum mobile under the hepatoduodenal ligament with a critical distension up to 7cm (Figure 1B, C). An urgent laparoscopy was performed and showed a distended colon positioned in the lesser sac. Due to the amount of distension, it was impossible to perform a laparoscopic reduction, so a conversion to laparotomy through a small upper abdominal incision was performed. Blunt dissection of the pars flaccida of the hepatogastric ligament was performed after which the caecum and appendix were identified (Figure 1D). Careful reduction was undertaken, however, due to the distension it was impossible to safely reduce the caecum. To lower the caecal pressure, the appendix was removed and an inverted suture was placed at the stump followed by a decompression of the caecum. The caecum could now be retracted from under the hepatoduodenal ligament. Because of a caecum mobile a classic right colectomy was carried out to lower the risk of recurrence. An abdominal lavage was then performed and the mesenteric defect created by the bowel resection was closed. The patient recovered quickly and could leave the hospital at the sixth postoperative day.
Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study
Published in Acta Chirurgica Belgica, 2018
Burak Veli Ülger, Eyüp Savaş Hatipoğlu, Özgür Ertuğrul, Mehmet Cudi Tuncer, Cihan Akgül Özmen, Mesut Gül
Blood is supplied to the liver by the proper hepatic artery and drained from the liver by the hepatic portal vein. Other hepatic veins also provide venous drainage. The branches of the proper hepatic artery, hepatic portal vein, and common hepatic duct constitute the portal triad. The right portal triad exhibits a short course (1–1.5 cm) before entering the porta hepatis (a deep fissure on the inferior surface of the liver through which all neurovascular structures—except the hepatic veins—and the hepatic ducts enter or exit the liver). After entering the right lobe, the portal triad divides into anterior and posterior branches that supply the paramedian (V and VIII) and the lateral (VI and VII) segments [4]. The left portal triad continues to the top of the hepatoduodenal ligament and then moves 3–4 cm to the left to run under the quadrate lobe. The triad then turns forward, accessing segments II, III, and IV from the ligamentum venosum fissure [5,6]. The caudate lobe has a left portion of fixed size and a right portion that varies individually in size. Both the right and left portal triads drain blood from the caudate lobe and also drain bile. The caudate process, which is on the right, delivers venous blood to branches from the fork of the hepatic portal vein and the right branch of that vein; the left part of the caudate lobe delivers blood only to the left branch of the hepatic portal vein. The combined venous blood from the caudate lobe drains into the inferior vena cava via a single vein [7].
Malignancy in elective cholecystectomy due to gallbladder polyps or thickened gallbladder wall: a single-centre experience
Published in Scandinavian Journal of Gastroenterology, 2021
Dennis Björk, Wolf Bartholomä, Kristina Hasselgren, David Edholm, Bergthor Björnsson, Linda Lundgren
The Swedish National Health Care Program for Gallbladder and Bile Duct Cancer recommends follow-up for polyps 5–9 mm in size and cholecystectomy for all gallbladder polyps ≥10 mm [1]. These recommendations are supported by several studies [3,8,14,15], while others consider polyp size alone to be insufficient for surgery [16–19]. In the early stages of gallbladder cancer (e.g. <pT1b), cholecystectomy is considered adequate treatment [20]. In more advanced stages, cholecystectomy combined with liver resection and resection of lymph nodes in the hepatoduodenal ligament is recommended. If indicated, resection of retropancreatic lymph nodes (nodal station 13) and those along the celiac trunk (nodal station 9) is also performed.