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Laparoscopic large hiatus hernia repair
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Alex Nagle, Geoffrey S. Chow, Nathaniel J. Soper
To initiate this dissection, the hepatogastric ligament is divided to gain access to the lesser sac and mobilize the lesser curvature of the stomach. In the case of a large type III PEH, a significant portion of the lesser curvature may lie intrathoracically and extreme care must be taken to identify the location of the left gastric artery, right gastric artery, and even porta hepatis, prior to dividing the hepatogastric liga- ment, as these structures can be shifted toward the hiatus. Once the lesser sac is entered, division of the lesser omentum continues superiorly to the level of the right crus. We use an ultrasonic dissector to accomplish this, although bipolar or monopolar energy devices can also be employed. The hepatic branch of the vagus nerve can be divided without physiologic consequence, as long as the surgeon has confirmed that an aberrant left hepatic artery is not present alongside it.
Management of peritoneal metastases using cytoreductive surgery and perioperative chemotherapy
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
The gallbladder is removed in a routine fashion from its fundus toward the cystic artery and cystic duct. These structures are ligated and divided. The hepatoduodenal ligament is characteristically heavily layered with tumor. After dividing the peritoneal reflection onto the liver, the cancerous tissue that coats the porta hepatis is bluntly stripped using a Russian forceps from the base of the gallbladder bed toward the duodenum. The right gastric artery going to the lesser omental arcade is preserved. Because the triangular ligament of the left lobe of the liver was resected in performing the left subphrenic peritonectomy, the left lateral segment of the liver may be retracted left to right to expose the hepatogastric ligament in its entirety. Under direct vision, the surgeon separates the gastrohepatic ligament from the fissure defined by the ligamentum venosum. Ball-tipped electrosurgery is used to electroevaporate tumor from the surface of the caudate process. Care is taken not to traumatize the anterior surface of the caudate process, for this can result in excessive and needless blood loss. The segmental blood supply to the caudate lobe is located on the anterior surface of this segment of the liver, and hemorrhage may occur with only superficial trauma. Also, care must be taken to avoid an accessory left hepatic artery that may arise from the left gastric artery and cross through the hepatogastric ligament. If the artery is embedded in tumor or its preservation occludes clear exposure of the omental bursa, the artery is ligated as it enters the liver parenchyma. It is resected as part of the hepatogastric ligament.
Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication
Published in Acta Chirurgica Belgica, 2020
Jan Colpaert, Julie Horevoets, Leander Maes, Gilles Uijtterhaegen, Bruno Dillemans
In essence, a laparoscopic 360° fundoplication was performed to reinforce the LES by wrapping the excluded stomach around the distal esophagus. The patient was put in beach chair position and a pneumoperitoneum of 15 mmHg was established. One scope trocar and four utility trocars were placed, using the same position as the initial gastric bypass surgery (Figure 1) [13]. After initial adhesiolysis from the previous surgery the excluded stomach is carefully isolated by dividing the short gastric vessels with harmonic scissors. Subsequently the lesser omentum (or hepatogastric ligament) is opened at the pars flaccida and dissection continues toward the diaphragm to expose the right crus. Further blunt dissection is used to separate the right crus from the esophagus. The dissection is then continued to free the esophagus circumferentially.
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.
Neonate with Congenital Duodenal Obstruction and Ectopic Hepatic Parenchyma
Published in Fetal and Pediatric Pathology, 2022
Shishir Kumar, Parveen Kumar, Khushboo Jha, Arti Khatri
The most common location of ELT as described in the literature is within the gallbladder, with presence in hepatogastric ligament, omentum, stomach, and umbilical ligaments also reported. Outside the abdominal cavity, ELT has been reported in pleural cavity, mediastinum, lung, and heart [4]. The current case was a true ectopic liver tissue without any connection to the native liver, and it did not fit into any subtypes described by Collan et al. The literature recognizes that this classification may not apply to all cases of ELT [5, 6].