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Abdominal surgery: General principles of access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Nigel J. Hall, Katherine A. Barsness
Special consideration is required for umbilical access in neonates and infants less than 1 year of age. During fetal circulation, the umbilical vein drains through the ductus venosus into the left hepatic vein, near its junction with the inferior vena cava. After birth, involution of the umbilical vein forms the falciform ligament. However, the age at which the natural patency of the remnant umbilical vein fully closes is not clearly defined. A number of case reports in the medical literature, as well as case law from malpractice lawsuits, document air embolism through the umbilical vein remnant to be a highly morbid or lethal complication of laparoscopy in infants. For this reason, both supraumbilical access and direct access through the center of the umbilicus should absolutely be avoided in neonates and infants. While the vast majority of air embolisms are noted to occur in infants of less than 3 months of age, the timing of full involution of the natural patency is not known. It should also be noted that air embolisms have been documented in cases when insufflation has not yet begun, hypothesized to be secondary to pushing air into the vein during advancement of a sheathed trocar into its Veress needle-placed sheath. Air embolism has also occurred at later stages of a procedure, when a trocar is either intentionally or inadvertently pulled back in the fascia, with resultant insufflation of the umbilical vein. As there is no absolutely safe method to place a trocar near the umbilical vein, it is therefore advised that all neonate and infant trocars be placed in an infraumbilical location.
Peritoneal metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
The falciform ligament is a common site of tumour deposits, which may be plaque-like or nodular, and can extend into the liver parenchyma (Figure 33.7). Similar deposits can occur in the fissures for the ligamentum teres and venosum (Figure 33.7). Deposits also occur around the gallbladder (Figure 33.8) and in the periportal region (Figure 33.9); from there the tumour can extend into the liver by tracking along the portal vein branches, and this is shown on CT as thickening and enhancement around these within the liver.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
The falciform ligament is dissected off the anterior abdominal wall and the liver; the ligamentum teres hepatis is followed centrally by opening the pont hepatique (Figure 9.13); at its most central point, this ligament is either divided with an energy device or transfixed using a non-absorbable suture (e.g. Prolene®).
Extended Ligation of the Hepatic Vein May Yield a Similar Effect to Liver Venous Deprivation in a Rat Model
Published in Journal of Investigative Surgery, 2023
Xiaoqin He, Yuefeng Zhang, Gaoshuo Zhang, Peng Ma, Liangkun Xiong, Wei Wang, Yangtao Xu, Yang Shen, Kaihuan Yu, Weixing Wang
Animals were anesthetized by inhalation of a mixture of 3% isoflurane (RWD, Shenzhen, China) mixed with pure oxygen at a flow rate of 0.5 L/min. The hair was shaved, and the abdominal skin was disinfected. Then, a 5.0-cm midline incision was made. The falciform ligament was released to fully expose the HVs (Figure 1B). After the operation, each animal was injected with 6 mL of a 5% glucose and sodium chloride solution containing 0.96 mg of gentamicin. Animals were placed on a heating pad to keep warm before recovery.
Internal herniation through the falciform ligament of the liver: a case report
Published in Acta Chirurgica Belgica, 2019
Gino Vissers, Arno Talboom, Ben Gys, Damien Desbuquoit, Niels Komen, Guy Hubens
Apart from the types described above, other less common types of internal herniation exist. We present a case of small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery. Though this type is very rare and accounts for only 0.2% of all internal hernias, there is a rise in incidence due to the increasing number of surgical cases being treated laparoscopically [8,9].
Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre
Published in Scandinavian Journal of Gastroenterology, 2018
Michael Lipinski, Michael Saborowski, Benjamin Heidrich, Dina Attia, Philipp Kasten, Michael P. Manns, Michael Gebel, Andrej Potthoff
All ultrasound examinations were performed or supervised according to a standardised protocol by experienced and certified personnel (DEGUM II or III examiners, for details: German Association of Ultrasound in Medicine, www.degum.de), that has performed >6000 ultrasound examinations per examiner and can document a frequency of more than 1000 abdomen ultrasounds per year per examiner (at least 8 years of experience), using ultrasound equipment Toshiba Aplio, Toshiba Aplio XG (Toshiba, Japan), Siemens Sonoline Elegra Advanced, Siemens Sonoline Antares and Siemens Acuson S2000 (Siemens, Germany). Systematic B-mode and Doppler ultrasound examinations of all abdominal organs and the retroperitoneum were performed according to the recommendations of the German Association of Ultrasound in Medicine (www.degum.de). The abdominal blood vessels were examined by B-mode and Doppler ultrasound and a PS was diagnosed if tortuous vessels were detected that originated from the portal, the splenic and/or the mesenteric veins, draining into the inferior vena cava or the renal vein. Special emphasis was put on the direction of flow in the splanchnic vein system (Supplementary Figure 1B). If an orthograd flow was detected in the main portal vein, the left portal branch was investigated first. UV shunts were diagnosed if a vessel from the left portal vein with hepatofugal flow towards the abdominal wall in anatomic proximity to the falciform ligament was present. In case a retrograde flow in the main portal vein was detected we checked for the direction of flow in the mesenteric and splenic veins. A retrograde flow in the splenic vein indicates a potential SR shunt. If a blood vessel connecting the splenic and the left renal vein was present and led to hemodynamic inflow turbulence, a splenorenal shunt was diagnosed. The detection of a retrograde flow in the mesenteric vein points towards a mesenteric shunt. These shunts were diagnosed if a connection between the mesenteric veins and the subhepatic inferior vena cava in conjunction with haemodynamic inflow turbulence into the cava vein was present. Combined shunts consisted of at least two of the above.