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 6 publications

(3 citation statements)

References 140 publications

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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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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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“…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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“…13 Although utilization of the falciform ligament as a vascularized flap for management of duodenal ulcer perforation has been described, it has long been thought of as an insignificant embryological remnant and sacrificed liberally with little consequence. [14][15][16] Be-cause injury to the falciform ligament has no clinical significance, no studies report the incidence of falciform ligament injuries after open or laparoscopic surgeries. In fact, division of the falciform ligament has been suggested for increasing exposure during laparoscopic cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

Midline epigastric scars can be associated with higher umbilical complications following DIEP flap harvest

Yang

Colakoğlu

Mureau

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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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 6 publications

References 140 publications

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

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

Midline epigastric scars can be associated with higher umbilical complications following DIEP flap harvest

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