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Surgical Anatomy of the Abdomen: 34

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The undulating splenic artery can be visualized above the body and tail of the pancreas in the posterior wall of the lesser sac. There it can be ligated in continuity to decompress a large spleen for safer and easier resection. Ligation should be done as far distal as practical to avoid compromising the splenic branches to the tail of the pancreas. 

Related topic: Splenomegaly from Polycythemia   

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Surgical Anatomy of the Abdomen: 35

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The esophageal hiatus is a muscular band originating in the right root of the diaphragm. The reflection of parietal peritoneum off the diaphragm onto the short intraabdominal esophageal segment and the underlying areolar tissue is called the esophagophrenic ligament. Dividing the ligament to mobilize the esophagus opens the lower mediastinum. The anterior vagus lies on the anterior surface of the esophagus, while the posterior trunk may be separated from the esophagus posteriorly, lying in the V of the right crus.

Related topics: Laparoscopic Nissen Fundoplication (Video)
Transhiatal Laparoscopic Esophageal Leiomyoma Resection  

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Surgical Anatomy of the Abdomen: 36

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The lower limit of the retroesophageal space is the left gastric artery accompanied by the celiac branch of the posterior vagus. To gain loose mobility of the fundus for a Nissen wrap, the tethering upper short gastrics and gastrosplenic ligament are divided. The loose, short Nissen wrap acts like the nipple valve in a basketball, exerting closing pressure on the lower esophagus when distended with gastric content (fluid and air). The crura may be tightened posteriorly and/or anteriorly.

Related topic: Laparoscopic Nissen Fundoplication (Video)   

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This page was last modified on 9/25/2005.