The standard operation included resection of the right or left hepatectomy with en-bloc resection of the caudate lobe with hepatoduodenal
lymph node dissection.
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).
On abdominal US, a few cystic LAPs were found in the hepatoduodenal
ligament and multiple LAPs were found in the inframesacolic ligament.
N1 lymph nodes are limited to the hepatoduodenal
ligament and stage wise are potentially resectable, while patients having N2 disease are considered to have metastatic disease (M1).
The most possible reason in this regard is disappearance of adhesion in the hepatoduodenal
ligament and right upper abdomen.
Systematic removal of LN station numbers 7 (left gastric artery), 8a and 8p (common hepatic artery), 9 (celiac artery), 11 (splenic artery), 12a and 12p/b (hepatoduodenal
ligament), 13 (retropancreatic), and 14v (superior mesenteric vein) was performed, whereas station 10 (splenic hilum) was removed optionally.
The mass was associated with multiple enlarged peripancreatic, porta hepatis and hepatoduodenal
lymph nodes, measuring up to 1.2 cm.
Therefore, the present case demonstrates an even more complicated vascular anatomy at the level of hepatogastric and hepatoduodenal
Intraoperatively, an extreme oedema in the pylorus, the transverse mesocolon, the head and body of the pancreas, and the hepatoduodenal
ligament was found.
Se encuentra sujeto a la pared abdominal por medio de elementos de fijacion (ligamentos redondo [que contiene la vena umbilical], suspensorio, coronales y triangulares derecho e izquierdo; ligamento hepatogastrico y hepatoduodenal
; a los que se ha de agregar la vena cava y el pediculo hepatico, compuesto por la vena porta, la arteria hepatica propia y el conducto coledoco) (Bismuth, 2013; Juza & Pauli).
During surgery, the structures of hepatoduodenal
ligament and porta hepatis were carefully dissected and a metal clip was found, placed just below hepatic duct confluence that involved about 3/4 width of the common hepatic duct (Fig.