In our experience, extensive invasion to the
hepatoduodenal ligament, excessive presence of liver or peritoneal metastases beyond areas near the gallbladder, or bulky lymph node metastases have been considered a contraindication to surgery.
After excluding metastases, we dissected the
hepatoduodenal ligament with a combination of hook diathermy and Harmonic ACE+7[R] (HA).
Gumbs and Hoffman [17] described a pT3 case of IGBC treated with full laparoscopic
hepatoduodenal ligament lymphadenectomy and resection of segments IVb and V; the frozen cystic stump margin was proven positive for tumor spread; therefore, a resection of the common bile duct was performed.
Course and Arrangement of Structures in
Hepatoduodenal LigamentD) Detail of the content of the dissected
hepatoduodenal ligament, showing the side-to-side anastomosis (arrow) between the aberrant branch (3) and the gastroduodenal artery (11).
The hepatic arterial and portal venous vasculature in the
hepatoduodenal ligament was identified and preserved.
Once the liver has been retracted and the
hepatoduodenal ligament has been lifted a tape can then be placed, acting as a tourniquet around the
hepatoduodenal ligament using a "Gold finger" (Gold finger, blunt dissector, Ethicon Endo surgery, Johnson & Johnson, USA) as previously described [17].
A mixed-density mass in the
hepatoduodenal ligament area was also discovered [Figure 1]a and [Figure 1]b.{Figure 1}
The
hepatoduodenal ligament was retracted to the right to expose the Spiegel lobe.
The Pringle manoeuvre, where both the common hepatic artery and portal vein are controlled in the
hepatoduodenal ligament, has a minimal haemodynamic effect, although the pathological liver does not tolerate it as well as a healthy liver.
Gall-bladder and
hepatoduodenal ligament lymphangioma - Case report and literature review.
MATERIAL AND METHODS: In the present study a total number of 60 human livers with
hepatoduodenal ligaments, duodenum, abdominal aorta with celiac trunk and superior mesenteric artery were removed en mass from the cadavers of both sexes.