Hepatic Dearterialization and Infusion Treatment of Liver Tumors
Hans-Inge Peterson in Tumor Blood Circulation: Angiogenesis, Vascular Morphology and Blood Flow of Experimental and Human Tumors, 2020
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
Use of the stomach as an esophageal substitute
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
The third vessel of the celiac trunk, the common hepatic artery, turns to the right, in the direction of the hepatoduodenal ligament of the small omentum. There it divides into the hepatic and gastroduodenal arteries. The hepatic artery runs through the hepatoduodenal ligament to the liver and usually gives rise to the right gastric artery, which proceeds to the lesser curvature of the stomach. The right gastric artery may also originate from the gastroduodenal artery. The gastroduodenal artery runs posterior to the superior part of the duodenum distal to the pylorus and comes out caudad to the duodenum, where it divides into the right gastroepiploic and superior pancreaticoduodenal arteries. All gastric arteries anastomose between themselves directly or indirectly by intramural or extramural branches. Therefore, the ligation of two or even three gastric arteries preserves the blood supply of the stomach under normal circumstances.
Abdomen
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
ligaments at its left and right edges) and anterior abdominal wall (falciform ligament), but is also kept in place by the hepatic veins that run directly into the inferior vena cava from the bare area (posterior part of liver with no peritoneal covering) lying in a deep groove on the posterior aspect of the liver. It has a large right and a small left lobe, but the caudate and quadrate lobes, which topographically are part of right lobe, are functionally part of the left lobe because, like the left lobe, they receive their blood supply from leji branches of the hepatic artery and portal vein; the main part of the right lobe receives blood from the right branches of these vessels. The caudal (inferior) surface, also known as the visceral surface, has near its centre the porta hepatis, where vessels and ducts enter and leave. The lesser omentum, the peritoneal fold that runs between the stomach and liver, is attached to the margins of the porta hepatis. Running in the right margin of the lesser omentum is the hepatoduodenal ligament in which lies the portal vein (posteriorly), hepatic artery (anteriorly) and bile duct (below and Fig.6.10).
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].
A single center comparative retrospective study of in situ split plus portal vein ligation versus conventional two-stage hepatectomy for cholangiocellular carcinoma
Published in Acta Chirurgica Belgica, 2023
Sascha Vaghiri, Salman Alaghmand Nejad, Laszlo Kasprowski, Dimitrios Prassas, Sami-Alexander Safi, Lars Schimmöller, Andreas Krieg, Alexander Rehders, Nadja Lehwald-Tywuschik, Wolfram Trudo Knoefel
Right trisegmentectomies were performed in 10 ISLT patients (62.5%) and in four patients of the PVE/TSH group (80%) followed by three right hepatectomies (18.8%) and three extended right hepatectomies (18.8%) in the ISLT group and one extended right hepatectomy after PVE (20%) (Table 2). In the PVE/TSH group, biliary reconstruction with a simple hepaticojejunostomy and complete dissection of the hepatoduodenal ligament was done in five patients. In addition, three patients underwent concomitant portal venous reconstruction. The median operative time in the PVE/TSH group was 513 min (IQR 465–740 min). During the first stage of ISLT, hepaticojejunostomy was necessary for 11 patients (68.8%) (simple n = 9, ≥2 n = 2). Arterial or venous reconstructions were conducted in six patients (37.5%). The median duration of the first stage in the ISLT group was 544 min (IQR 476–603 min). Upon completion of the second stage, additional biliary reconstruction was performed in eight ISLT patients (50%) with three (18.8%) portal venous reconstructions. The median recorded procedure time of the second stage was 228 min (IQR 119–338 min) (Table 2). Notably, four patients with insufficient volume growth after upfront PVE received Salvage ISLT after a median of 52 days (IQR 45–58 days) and were included in our ISLT group.
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.
Related Knowledge Centers
- Lesser Omentum
- Porta Hepatis
- Common Bile Duct
- Liver
- Duodenum
- Lobules of Liver
- Hepatic Artery Proper
- Portal Vein
- Pringle Manoeuvre
- Hepatogastric Ligament