The falciform ligament and the ligamentum teres: friend or foe

Bills, D. G.; Moore, Suzanne

doi:10.1111/j.1445-2197.2009.05050.x

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…With the better understanding of the richness of its anatomical and histological structures, its use in routine surgical procedures has again gained interest in recent years. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

“…With the better understanding of the richness of its anatomical and histological structures, its use in routine surgical procedures has again gained interest in recent years. [19] In the literature, there is the limited number of clinical studies on the use of falciform ligament patch for repair of PUP. The majority of these studies are single case reports or small case series, with good surgical outcomes.…”

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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“…With the better understanding of the richness of its anatomical and histological structures, its use in routine surgical procedures has again gained interest in recent years. [ 19 ]…”

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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“…In adults, the round ligament is located at the edge of the free ligament (falciform ligament). Therefore, the falciform ligament has a similar hypervascular omentum [ 14 , 15 ]. In addition, the falciform ligament can also be flexibly used to repair damage to the bile ducts; cover a diaphragmatic hole, create an anti-oesophageal reflux valve, surround the outside oesophageal anastomosis after total gastrectomy, cover the gallbladder bed to stop haemostasis or prevent bleeding and bile leakage; it can even be used to form artificial arteries [ [16] , [17] , [18] , [19] ].…”

Section: Discussionmentioning

confidence: 99%

“…With adequate mobilization, the falciform ligament can serve as a viable pedicle to achieve closure of perforations in the first portion of the duodenum [ 8 ]. The middle segment artery of the liver and the left phrenic artery provide the main blood supply of the falciform ligament, making it a well-vascularized structure to be used as a flap [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of surgical management of peptic ulcer perforation using the falciform ligament: A cross-sectional study at a single centre in Vietnam

Sơn

Học

Hương

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Peptic ulcer perforation (PUP) is one of the most common critical surgical emergencies. The omentum flap is commonly used to cover a PUP. However, the omentum cannot be used in cases of severe peritonitis or previous surgical removal. This is the first study conducted in Vietnam that was designed to analyse the outcomes of patients with PUPs who were treated using the falciform ligament. Method In this study, we retrospectively identified 40 consecutive patients who were treated for PUP at a single high-volume centre in Vietnam from February 2018 to February 2021. Peptic ulcer perforation was measured during diagnostic evaluation based on preoperative imaging, such as X-ray, and CT scan. Patients who had malignancy, laparoscopic surgery, omentopexy and nonoperative treatment were excluded from this research. Results Forty patients were included; the mean age of the patients was 66.3 years (range 33–99 years), and some patients had comorbid disease (57.5%), hypertension (30%), diabetes (10%), cirrhosis (7.5%), and chronic renal failure (7.5%). The PUPs were located in the duodenum (80%), or the pyloric (15%) and prepyloric (5%) regions. The procedures used to treat the patients included duodenostomy (32.5%), gastrojejunostomy (37.5%), and antrum resection (2.5%). The average operative time was 88.6 min (45–180 min), hospital stay was 9.6 days (2–35 days), and oral intake was started at 4.1 days (3–8 days); additionally, the 30-day mortality (17.5%) and incidences of pneumonia (25%), multiorgan failure (15%), acute liver failure (5%), wound infection (7.5%), and ulcer peptic fistula (0%) were assessed. Univariate tests showed that an ASA ≥ III and comorbidities, such as pulmonary complications, liver failure and multiorgan failure, were associated with mortality. The multivariate test showed that multiorgan failure was the only factor related to mortality. Conclusion The falciform ligament can be efficiently used for the closure of a PUP. Although there were no instances of complication with a reperforated peptic ulcer, the mortality rate was slightly highly related to severe comorbidities and postoperative multiorgan failure.

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“…The Inferior Sappey's veins drain the caudal portion of the falciform ligament and anastomose with the inferior epigastric and subcutaneous veins. The inferior group of veins could drain into the left portal vein, into the umbilical vein (not common), or directly into the caudate liver lobe [62][63][64][65][66].…”

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confidence: 99%

Surgical Anatomy of the Liver—Significance in Ovarian Cancer Surgery

Kostov

Selçuk²,

Watrowski

et al. 2023

Diagnostics

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Introduction: Ovarian cancer is the leading cause of death among all gynecological malignancies. Most patients present with an advanced stage of the disease. The routes of spread in ovarian cancer include peritoneal dissemination, direct invasion, and lymphatic or hematogenous spread, with peritoneal and lymphatic spread being the most common among them. The flow direction of the peritoneal fluid makes the right subphrenic space a target site for peritoneal metastases, and the most frequently affected anatomical area in advanced cases is the right upper quadrant. Complete cytoreduction with no macroscopically visible disease is the most important prognostic factor. Methods: We reviewed published clinical anatomy reports associated with surgery of the liver in cases of advanced ovarian cancer. Results: The disease could disseminate anatomical areas, where complex surgery is required—Morrison’s pouch, the liver surface, or porta hepatis. The aim of the present article is to emphasize and delineate the gross anatomy of the liver and its surgical application for oncogynecologists. Moreover, the association between the gross and microscopic anatomy of the liver is discussed. Additionally, the vascular supply and variations of the liver are clearly described. Conclusions: Oncogynecologists performing liver mobilization, diaphragmatic stripping, and porta hepatis dissection must have a thorough knowledge of liver anatomy, including morphology, variations, functional status, potential diagnostic imaging mistakes, and anatomical limits of dissection.

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The falciform ligament and the ligamentum teres: friend or foe

Cited by 14 publications

References 9 publications

The feasibility of falciformopexy in the repair of peptic ulcer perforation

The feasibility of falciformopexy in the repair of peptic ulcer perforation

Outcomes of surgical management of peptic ulcer perforation using the falciform ligament: A cross-sectional study at a single centre in Vietnam

Surgical Anatomy of the Liver—Significance in Ovarian Cancer Surgery

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