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Surgical Anatomy of the Abdomen: 37

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Usually, the only anatomic structure in the upper end of the gastrohepatic omentum is the hepatic branch of the anterior vagus. Since cholecystokinin is the major stimulus to gallbladder contraction, division of the hepatic branch is not a major concern when dividing this membrane. However, a relatively common (~10%) variation encountered in this location is an accessory or replaced left hepatic artery arising from the left gastric. If the vessel is a replaced left hepatic, there might be some concern with dividing it, although most (60%) of hepatic blood supply comes from the portal vein, and the left lobe may still survive. 

Related topics: Transhiatal Laparoscopic Esophageal Leiomyoma Resection,
Aberrant Left Hepatic Artery: Clinical Example  

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Surgical Anatomy of the Abdomen: 38

A D V E R T I S E M E N T

   

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During routine abdominal exploration, the body and tail of the pancreas are palpated with the flat of the hand through the body of the stomach. Access to the posterior aspect of the head of the pancreas is obtained by mobilizing the duodenal C-loop (Kocher maneuver.) 

Related topics: Laparoscopic Distal Pancreatectomy for Pancreatic Mucinous Cystic NeoplasmWhipple for Pancreatic Carcinoma  

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Surgical Anatomy of the Abdomen: 39

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If a more careful examination of the body and tail of the pancreas is required, the lesser sac is entered by opening the gastrocolic ligament outside the gastroepiploic arcade. Toward the right side of the gastroepiploic arcade, the gastrocolic ligament tends to lie atop the transverse colon mesentery. Attempting to enter the lesser sac at this location may result in penetrating the mesocolon as well and injuring the middle colic vessels. Easier and safer entry is obtained toward the left side of the arcade. The third part of the duodenum lies in the crotch of the superior mesenteric artery. Patients in body casts or after dramatic weight loss may develop compression at this point (nutcracker syndrome). 

Related topic: Total Colectomy and J-Pouch    

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