Vasudevan Baskaran1, Jayant Kumar Banerjee2, Sita Ram Ghosh3, Sukumar Santosh Kumar4, Subramaniam Anand5, Govind Menon6, Deep Shikha Mishra5, Ramanathan Saranga Bharathi7. 1. Department of Gastro-intestinal Surgery, MIOT Hospital, Chennai, India. 2. Department of Gastro-intestinal Surgery, Bharati Vidyapeeth Medical College, Pune, India. 3. Department of Gastro-intestinal Surgery, Command Hospital (Eastern Command), Kolkata, India. 4. Department of Gastro-intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, 226002, India. 5. Department of Surgery, Armed Forces Medical College, Pune, India. 6. Department of Plastic & Reconstructive Surgery, Command Hospital (Central Command), Lucknow, India. 7. Department of Gastro-intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, 226002, India. sarangabharathi@gmail.com.
Abstract
BACKGROUND AND PURPOSE: Despite their ubiquitous presence, easy availability and diverse possibilities, falciform ligament and hepatic round ligament have been used less frequently than their potential dictates. This article aims to comprehensively review the applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery and assess their utility and efficacy. METHODS: Medical literature/indexing databases were searched, using internet search engines, for pertinent articles and analysed. RESULTS: The studied flap and graft have found utility predominantly in the management of diaphragmatic hernias, gastro-oesophageal reflux disease, peptic perforations, biliary reconstruction, venous reconstruction, post-operative pancreatic fistula, post-pancreatectomy haemorrhage, hepatic cyst cavity obliteration, liver bleed, sternal dehiscence, splenectomy, reinforcement of aortic stump, feeding access, diagnostic/therapeutic access into portal system, composite tissue allo-transplant and ventriculo-peritoneal shunting where they have exhibited the desired efficacy. CONCLUSIONS: Hepatic round ligament/falciform ligament flap and graft are versatile and have multifarious applications in abdominal surgery with some novel and unique uses in hepatopancreaticobiliary surgery including liver transplantation. Their evident efficacy needs wider adoption to realise their true potential.
BACKGROUND AND PURPOSE: Despite their ubiquitous presence, easy availability and diverse possibilities, falciform ligament and hepatic round ligament have been used less frequently than their potential dictates. This article aims to comprehensively review the applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery and assess their utility and efficacy. METHODS: Medical literature/indexing databases were searched, using internet search engines, for pertinent articles and analysed. RESULTS: The studied flap and graft have found utility predominantly in the management of diaphragmatic hernias, gastro-oesophageal reflux disease, peptic perforations, biliary reconstruction, venous reconstruction, post-operative pancreatic fistula, post-pancreatectomy haemorrhage, hepatic cyst cavity obliteration, liver bleed, sternal dehiscence, splenectomy, reinforcement of aortic stump, feeding access, diagnostic/therapeutic access into portal system, composite tissue allo-transplant and ventriculo-peritoneal shunting where they have exhibited the desired efficacy. CONCLUSIONS: Hepatic round ligament/falciform ligament flap and graft are versatile and have multifarious applications in abdominal surgery with some novel and unique uses in hepatopancreaticobiliary surgery including liver transplantation. Their evident efficacy needs wider adoption to realise their true potential.
Authors: Marcelo E Facciuto; Manuel I Rodriguez-Davalos; Manoj K Singh; Juan P Rocca; Caroline Rochon; Wei Chen; Umadevi S Katta; Patricia A Sheiner Journal: Surgery Date: 2009-02-14 Impact factor: 3.982