Applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery—a review of their utility and efficacy

Vasudevan, Baskaran; Banerjee, Jayant Kumar; Ghosh, Sita Ram; Kumar, Sukumar Santosh; Anand, Sunil; Menon, Govind; Mishra, Deep Shikha; Bharathi, Ramanathan Saranga

doi:10.1007/s00423-020-02031-6

Cited by 9 publications

(8 citation statements)

References 140 publications

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“…[ 17 ] On the other hand, there are reports demonstrating that repair of PUP using the falciform ligament is as effective as the omentopexy. [ 18 ] In this study, the most frequently used technique for the PUP repair, the modified Graham omentopexy, was compared with the less used alternative method, falciformopexy.…”

Section: Discussionmentioning

confidence: 99%

“…Its thin double membranous structure is also an important feature that supports its use as a graft. [ 18 ] Anatomically, the falciform ligament is located just above the gastroduodenal junction, where PUPs are most common. Thus, a flap prepared from the falciform ligament can be placed easily and without tension over the perforation, making it ergonomic for surgeons.…”

Section: Discussionmentioning

confidence: 99%

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The feasibility of falciformopexy in the repair of peptic ulcer perforation

Terzioğlu

2023

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Modified Graham omentopexy is the most commonly used operative technique in the repair of peptic ulcer perforation (PUP); however, there is little data on falciformopexy in the literature. The aim is to investigate the feasibility of falciformopexy in the repair of PUP, comparing with modified Graham omentopexy. METHODS: Data of 471 patients who were operated for PUP were retrospectively analyzed. Patients’ demographics, pre-operative basic laboratory findings, American Society of Anesthesiologists (ASA) status, operative findings, and post-operative complications were recorded. The patients were classified into two groups modified Graham omentopexy and falciformopexy, and then compared with each other in terms of clinical characteristics, operative findings, and post-operative complications. RESULTS: Modified Graham omentopexy and falciformopexy were performed in 425 (90.2%) and 46 (9.8%) patients, respectively. The two groups were similar in terms of basic patient characteristics and pre-operative laboratory findings (P>0.05). ASA physical status was significantly different between the groups (P=0.001). No statistically significant difference was found between the groups in terms of complications, except for an anastomotic leak. Anastomotic leak was observed more frequently in patients who underwent falciformopexy than in patients with modified Graham omentopexy (P=0.017). CONCLUSION: Although falciformopexy technique has a higher rate of leak compared to the modified Graham omentopexy method, it should be kept in mind as an alternative method for repair of PUP, especially in cases where omentopexy cannot be applied for various reasons such as the presence of unavailable or unsuitable omentum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The feasibility of falciformopexy in the repair of peptic ulcer perforation

Terzioğlu

2023

Ulus Travma Acil Cerrahi Derg

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“…6 Fixation of the ligamentum teres flap to the ventral wall of the gastric conduit. Laparoscopic view toward the hiatus after perforated duodenal ulcers, covering of a pancreatic stump after pancreas resections and various vessel and bile duct reconstructions [14]. Promising short-term results have been published for the ligamental repair of small primary hiatal hernias; however, recurrence rates were as high as 60% for large hiatal defects (> 9 cm) [15,16].…”

Section: Discussionmentioning

confidence: 99%

Ligamentum teres augmentation (LTA) for hiatal hernia repair after minimally invasive esophageal resection: a new use for an old structure

Runkel

Kuvendjiska

Marjanović

et al. 2021

Langenbecks Arch Surg

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Purpose Hiatal hernias with intrathoracic migration of the intestines are serious complications after minimally invasive esophageal resection with gastric sleeve conduit. High recurrence rates have been reported for standard suture hiatoplasties. Additional mesh reinforcement is not generally recommended due to the serious risk of endangering the gastric sleeve. We propose a safe, simple, and effective method to close the hiatal defect with the ligamentum teres. Methods After laparoscopic repositioning the migrated intestines, the ligamentum teres is dissected from the ligamentum falciforme and the anterior abdominal wall. It is then positioned behind the left lobe of the liver and swung toward the hiatal orifice. Across the anterior aspect of the hiatal defect it is semi-circularly fixated with non-absorbable sutures. Care should be taken not to endanger the blood supply of the gastric sleeve. Results We have used this technique for a total of 6 patients with hiatal hernias after hybrid minimally invasive esophageal resection in the elective (n = 4) and emergency setting (n = 2). No intraoperative or postoperative complications have been observed. No recurrence has been reported for 3 patients after 3 months. Conclusion Primary suture hiatoplasties for hiatal hernias after minimally invasive esophageal resection can be technically challenging, and high postoperative recurrence rates are reported. An alternative, safe method is needed to close the hiatal defect. Our promising preliminary experience should stimulate further studies regarding the durability and efficacy of using the ligamentum teres hepatis to cover the hiatal defect.

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“…The chosen wrap is carefully positioned to cover the major arteries and veins and secured in place with nonabsorbable sutures. From the above options for the protection of divided or skeletonized vessels, the use of a teres/falciform ligament has become the most frequently applied technique due to evidence for its effectiveness in published case series [29][30][31][32][33], systematic reviews [34][35][36], and a recent randomized clinical trial [37].…”

Section: Peripancreatic Vessel Wrapmentioning

confidence: 99%

Surgical Options to Mitigate the Consequences of Pancreatic Anastomosis Leak after Pancreaticoduodenectomy

Saroglu¹,

Julianov²

2023

Pancreatic Cancer- Updates in Pathogenesis, Diagnosis and Therapies

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Pancreaticoduodenectomy is still the only treatment option that offers a chance to cure patients with pancreatic cancer and malignant periampullary tumors. Pancreaticojejunal anastomosis is the preferred method of reconstruction after pancreaticoduodenectomy. However, because of the high incidence of anastomotic leak and subsequent severe consequences, pancreaticojejunal anastomosis still remains the Achilles’ heel of the operation. Several technical modifications of pancreaticojejunal anastomosis exist, but none completely eliminates anastomotic leak, postoperative pancreatic fistula, or severe complications. Therefore, considerable efforts have been made to study and develop surgical options that can mitigate the severity and avoid fatal consequences of postoperative pancreatic fistula. This chapter presents and discusses some of the existing and emerging surgical strategies devoted to mitigating the catastrophic consequences of pancreatic anastomotic leaks.

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Applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery—a review of their utility and efficacy

Cited by 9 publications

References 140 publications

The feasibility of falciformopexy in the repair of peptic ulcer perforation

The feasibility of falciformopexy in the repair of peptic ulcer perforation

Ligamentum teres augmentation (LTA) for hiatal hernia repair after minimally invasive esophageal resection: a new use for an old structure

Surgical Options to Mitigate the Consequences of Pancreatic Anastomosis Leak after Pancreaticoduodenectomy

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