The New Interest of Bariatric Surgeons in the Old Ligamentum Teres Hepatis
- PDF / 574,538 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 4 Downloads / 162 Views
REVIEW
The New Interest of Bariatric Surgeons in the Old Ligamentum Teres Hepatis Alexander Runkel 1 & Oliver Scheffel 2 & Goran Marjanovic 3 & Norbert Runkel 2 Received: 26 March 2020 / Revised: 7 June 2020 / Accepted: 9 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The search for an operation that effectively prevents and treats intrathoracic gastric migration (ITGM) after bariatric surgery has revived a long-forgotten technique: ligamentum teres cardiopexy (LTC) by which a vascularized flap of the teres ligament is wrapped around the distal esophagus. The systematic search of publications in the English language revealed 4 studies (total number of patients 53) in the non-bariatric literature with an unsatisfactory resolution of GERD. There were 5 reports from the bariatric literature with small patient numbers (total 64) and a short follow-up (6–36 months). There were no objective signs of gastric remigration in 93% of investigated patients. Acknowledging the limitations of these preliminary reports, bariatric surgeons are encouraged to further investigate the potentials of LTC in their patients. Keywords Ligamentum teres hepatis . Round ligament . Intrathoracic gastric migration . Hiatal hernia . GERD . Sleeve gastrectomy . Bariatric surgery
Abbreviations LTC Ligamentum teres cardiopexy ITGM Intrathoracic gastric migration GERD Gastroesophageal reflux disease SG Sleeve gastrectomy RYGB Roux-en-Y gastric bypass OAGB One anastomosis gastric bypass
* Norbert Runkel [email protected] Alexander Runkel [email protected] Oliver Scheffel [email protected] Goran Marjanovic [email protected] 1
Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany
2
Department of Obesity and Metabolic Surgery, German Centre of Excellence, Sana-Klinikum Offenbach, Starkenburgring 66, 63069 Offenbach, Germany
3
Centre for Obesity and Metabolic Surgery, Department of General and Visceral Surgery, University of Freiburg Medical Centre, Freiburg, Germany
BMI LES
Body mass index Lower esophageal sphincter
Introduction The ligamentum teres hepatis (also known as the round ligament of the liver) is the remnant of the umbilical vein, which once travelled from the placenta to the liver to deliver oxygenated and nutrient-rich blood to the fetal body circulation. The teres ligament is the free, inferior edge of the falciform ligament, which is a thin, sickle-shaped fibrous structure that connects the anterior part of the liver to the ventral wall of the abdomen [1]. The main arterial supply to the ligamentum teres hepatis is from the ligament branch of the middle hepatic artery which runs through the liver fissure [2] (Fig. 1a, b). This is the anatomical basis of the vascularized ligamentum teres hepatis pedicle flap [3]. The ligamentum teres hepatis has long been thought of as an insignificant embryological remnant; however, general surgeons increasingly use the ligamental flap for the closure of perf
Data Loading...
