Teres Hepatis Research Articles

Morphological and Morphometric Parameters of the Liver of Newborn Male Rabbits Alexander

Introduction. At present, the study of age-related issues of the liver structure in animals is one of the most important objectives of morphology, since liver diseases occupy one of the leading places among the nosologies causing death of newborn animals, in particular rabbits. At the same time, although the data on the micromorphological structure of the digestive tract of rabbits is extensive, the data on the age-related anatomy of the liver in the animals under study is scarce in the available literature. The aim of the paper is to determine the morphofunctional features of the liver of newborn male rabbits.Materials and Methods. The objects of the study were newborn male rabbits of the “butterfly” breed (n=9), who had no deviations in development and constitution. To establish the anatomical and topographic features and morphometric parameters of the liver of the animals under study, the standard anatomical dissection, Pirogov's cuts, macromorphometric and statistical research methods were used.Results. It has been established that the liver of newborn male rabbits of “butterfly” breed has segmental nature, the caudate process is large, distinct from the other lobes. The papillary process is oval in shape, poorly developed, adjacent to the lesser curvature of the stomach. The quadrate and right lobes of the liver are well developed, and the left lobes are less developed, which entails the horizontal position of the organ. The ligamentous attachments of the liver are well developed. A round ligament of liver (ligamentum teres hepatis) with fetal hepatic vessels can be distinguished. The linear and weight parameters of the liver are characterised by the small absolute and large relative values. The liver index is inversely proportional to the body weight of an animal and is 5.91.Discussion and Conclusion. The obtained morphological and morphometric data is aimed at establishing the standard liver parameters of the clinically healthy newborn male rabbits of the “butterfly” breed. The liver boundaries have been defined taking into account the length, width, thickness parameters of each lobe separately. The organ topography has been defined including the skeletotopy, holotopy and syntopy of the individual lobes and processes of the liver.

Utility of ligamentum teres hepatis flap reinforcement to prevent postoperative pancreatic fistulas in robotic distal pancreatectomy

BackgroundPostoperative pancreatic fistula (POPF) is a significant contributor to morbidity and mortality after robotic distal pancreatectomy (RDP). Ligamentum teres hepatis (LTH) reinforcement of the pancreatic remnant may reduce the incidence of POPF. MethodsPatients ≥18 years old, who underwent RDP at the University of Massachusetts Memorial Medical Center from 01/01/2018-08/31/2022. Primary endpoint was POPF incidence. Secondary outcomes included peri- and postoperative variables. ResultsThirty-three patients underwent RDP, of which LTH reinforcement was used in 21 (64 ​%) cases. Six (18 ​%) patients developed a POPF. No association was identified between LTH flap reinforcement and POPF (OR 1.18, 95 ​% CI 0.18 to 7.85, p ​= ​0.87). There were no peri- or postoperative complications related to ligamentum teres flap creation. ConclusionsLTH reinforcement of the pancreatic remnant can be safely performed during RDP. Further studies are needed to assess the utility of this intervention to mitigate the risk of pancreatic fistula formation following RDP.

Prevention of postpancreatectomy hemorrhage after laparoscopic pancreaticoduodenectomy by wrapping ligamentum teres hepatis surrounding hepatic portal artery

Postpancreatectomy hemorrhage (PPH) is an important risk factor for postoperative complications after laparoscopic pancreaticoduodenectomy (LPD). Recent studies have reported that the use of ligamentum teres hepatis (LTH) in LPD may reduce the risk of PPH. Therefore, this study aims to investigate whether wrapping the hepatic hilar artery with the LTH can reduce PPH after LPD. We reviewed the data of 131 patients who underwent LPD in our team from April 2018 to December 2023. The patients were divided into Groups A (60 patients) and B (71 patients) according to whether the hepatic portal artery was wrapped or not. The perioperative data of the two groups were compared to evaluate the effect of LTH wrapping the hepatic hilar artery on LPD. The platelet count of Group A was (225.25 ± 87.61) × 10^9/L, and that of Group B was (289.38 ± 127.35) × 10^9/L, with a statistically significant difference (p < 0.001). The operation time of group A [300.00 (270.00, 364.00)] minutes was shorter than that of group B [330.00 (300.00, 360.00)] minutes, p = 0.037. In addition, A set of postoperative hospital stay [12.00 (10.00, 15.00)] days shorter than group B [15.00 (12.00, 19.50)] days, p < 0.001. No PPH occurred in Group A, while 8 patients in Group B had PPH (7 cases of gastroduodenal artery hemorrhage and 1 case of proper hepatic artery hemorrhage), p = 0.019. The new technique of wrapping the hepatic hilar artery through the LTH can effectively reduce the occurrence of PPH after LPD.

Safety and Feasibility of Electro-Vaporization of Ligamentum Teres Hepatis in Totally Laparoscopic Gastrectomy.

Introduction: The ligamentum teres hepatis may block the field of vision during totally laparoscopic gastrectomy (TLG), especially in patients with obesity. Aim: We used electrocautery to increase the visual field of TLG by shrinking the ligamentum teres hepatis. This procedure is termed electro-vaporization of the ligamentum teres hepatis (EVLTH). Methods: Patients with body mass index (BMI) ≥24 who underwent total laparoscopic distal gastrectomy (TLDG) or total laparoscopic total gastrectomy (TLTG) between January 2020 and December 2023 were retrospectively enrolled. According to the scope of gastrectomy and whether the patients underwent EVLTH, the patients were divided into the TLDG-EVLTH, TLDG-NEVLTH, TLTG-EVLTH, and TLTG-NEVLTH groups. The clinical characteristics, surgical outcomes, and pathological features were compared between the TLDG-EVLTH and TLDG-NEVLTH groups and the TLTG-EVLTH and TLTG-NEVLTH groups. Results: This study included 65 patients who underwent TLDG (EVLTH: NEVLTH = 29:36) and 32 patients who underwent TLTG (EVLTH:NEVLTH = 15:17). There were no significant differences in clinical characteristics, surgical outcomes, and pathological features between the TLDG-EVLTH and TLDG-NEVLTH groups. However, the operation time in the TLTG-EVLTH group was significantly shorter than that in the TLTG-NEVLTH group, and the difference was statistically significant, although differences in other data were not statistically significant. Conclusions: EVLTH is a simple and safe procedure that reduces the operation time of TLTG in patients who are overweight and enhances the field of vision of TLG.

Efficacy of the two-parts wrapping technique in reducing postoperative complications in laparoscopic pancreaticoduodenectomy.

The advancement of laparoscopic technology has broadened the application of laparoscopic pancreaticoduodenectomy (LPD) for treating pancreatic head and ampullary tumors. Despite its benefits, postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH) remain significant complications. Ligamentum teres hepatis wrapping around the gastroduodenal artery (GDA) stump show limitations in reducing POPF and PPH. This study retrospectively analyzed patients undergoing LPD from January 2016 to October 2023, We compared the effectiveness of the two-parts wrapping (the ligamentum teres hepatis wrapping of the gastroduodenal artery stump and the omentum flap wrapping of the pancreatojejunal anastomosis) and ligamentum teres hepatis wrapping around the gastroduodenal artery (GDA) in reducing postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH), using propensity score matching for the analysis. A total of 172 patients were analyzed, showing that the two-parts wrapping group significantly reduced the rates of overall and severe complications, POPF, and PPH compared to ligamentum teres hepatis wrapping around the GDA group. Specifically, the study found lower rates of grade B/C POPF and no instances of PPH in the two-parts wrapping group, alongside shorter postoperative hospital stays and drainage removal times. These benefits were particularly notable in patients with soft pancreatic textures and pancreatic duct diameters of < 3mm. The two-parts wrapping technique significantly reduce the risks of POPF and PPH in LPD, offering a promising approach for patients with soft pancreas and pancreatic duct diameter of < 3mm.

Ligamentum teres hepatis incarcerated within linea alba hernia: A case report

Abstract Incarcerated linea alba hernia is a rare form of ventral hernia. Most of these contain pre-peritoneal fat or the omentum. Herniation of containing ligamentum teres hepatis is seldom seen. A 52-year-old man presented with an abdominal wall mass and dull pain for 2 weeks. Computed tomography and ultrasound examination of the abdomen revealed an epigastrium linea alba hernia containing the liver round ligament. A hernial sac of size 3 cm × 4 cm was explored by laparoscopic surgery and successfully managed with hernia repair.

An Analysis of the Anomalous Fissure of the Ligamentum Teres Hepatis: A Morphological Perspective in the North Indian Population.

Background The liver, being the largest internal organ of the body shows a variety of gross morphological variations about lobes, fissures and processes which may be clinically significant. Among various anatomical variations, the most found is the variant fissure for ligamentum teres hepatis.The present study was done to classify, review, compare and discuss the literature for anomalies in fissures for ligamentum teres hepatis. Methods A total of 100 formalin-preserved human livers were obtained from the Department of Anatomy of King George's Medical University, Lucknow, and studied for one year. Result In our study, 15% of the liver showed morphological variations in fissures for ligamentum teres hepatis. These were classified into four types. In type I (2%), the fissure was converted into a tunnel by pons hepatis. In type II (3%), there was an incomplete fissure for ligamentum teres hepatis extending into the diaphragmatic surface.In type III (4%), there was an incomplete fissure for ligamentum teres hepatis present only on the visceral surface. In type IV (6%), the fissure was covered by a thin membrane. Conclusion In this study of the North Indian population, 15% ofliver have gross morphological variations. So thorough anatomical knowledge of the existence of variant or abnormal surface features on the liver isimperativeto understanding the underlying pathology for radiologists and surgeons so that a favorable outcome can be achieved.

Wrapping gastroduodenal artery stump with the teres hepatis ligament to prevent postpancreatectomy hemorrhage after pancreaticoduodenectomy

BackgroundGastroduodenal artery (GDA) stump erosion hemorrhage is a fatal complication after pancreaticoduodenectomy. This study aimed to determine whether GDA stump wrapping with the teres hepatis ligament during pancreaticoduodenectomy decreased the incidence of postpancreatectomy hemorrhage (PPH).MethodsWe reviewed 307 patients who had undergone pancreaticoduodenectomy between March 2019 and June 2022. The patients were divided into two groups according to application of GDA stump wrapping with the teres hepatis ligament: GDA wrapping group (165 patients) and no-wrapping group (142 patients). The perioperative data were compared between the groups.ResultsThe clinical characteristics were balanced between the two groups. Grades B and C PPH and GDA-stump-related hemorrhage were significantly reduced in the GDA wrapping group compared with the no-wrapping group (PPH B/C, 13.4% vs 6.1%, P = 0.029; GDA hemorrhage, 5.6% vs 0.6%, P = 0.014). No difference was observed in the incidence of clinically relevant postoperative pancreatic fistula, biliary leak, intra-abdominal abscess, delayed gastric emptying, 90-day mortality, and postoperative hospital stay between the two groups.ConclusionWrapping GDA stump with the teres hepatis ligament reduced the incidence of GDA-stump-related PPH. Therefore, the wrapping technique is a simple and effective strategy to prevent PPH. Prospective studies are needed to confirm the benefit of this procedure.

Predicting portal venous anomalies by left-sided gallbladder or right-sided ligamentum teres hepatis: A large scale, propensity score-matched study.

Right-sided ligamentum teres (RSLT) is often associated with portal venous anomalies (PVA) and is regarded as a concerning feature for hepatobiliary intervention. Most studies consider RSLT to be one of the causes of left-sided gallbladder (LGB), leading to the hypothesis that LGB must always be present with RSLT. However, some cases have shown that right-sided gallbladder (RGB) can also be present in livers with RSLT. To highlight the rare variation that RSLT may not come with LGB and to determine whether ligamentum teres (LT) or gallbladder location is reliable to predict PVA. This study retrospectively assessed 8552 contrast-enhanced abdominal computed tomography examinations from 2018 to 2021 [4483 men, 4069 women; mean age, 59.5 ± 16.2 (SD) years]. We defined the surrogate outcome as major PVAs. The cases were divided into 4 subgroups according to gallbladder and LT locations. On one hand, we analyzed PVA prevalence by LT locations using gallbladder location as a controlled variable (n = 36). On the other hand, we controlled LT location and computed PVA prevalence by gallbladder locations (n = 34). Finally, we investigated LT location as an independent factor of PVA by using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). We found 9 cases of RSLT present with RGB. Among the LGB cases, RSLT is associated with significantly higher PVA prevalence than typical LT [80.0% vs 18.2%, P = 0.001; OR = 18, 95% confidence interval (CI): 2.92-110.96]. When RSLT is present, we found no statistically significant difference in PVA prevalence for RGB and LGB cases (88.9 % vs 80.0%, P > 0.99). Both PSM and IPTW yielded balanced cohorts in demographics and gallbladder locations. The RSLT group had a significantly higher PVA prevalence after adjusted by PSM (77.3% vs 4.5%, P < 0.001; OR = 16.27, 95%CI: 2.25-117.53) and IPTW (82.5% vs 4.7%, P < 0.001). RSLT doesn't consistently coexist with LGB. RSLT can predict PVA independently while the gallbladder location does not serve as a sufficient predictor.

Comparative analysis of the results of reconstruction of the cardioesophageal transition of the liver round connection and fundoplication by the Nissen–Rosetti method in treatment of hernias

The paper presents a comparative characteristic of the results of surgical treatment of 27 patients with hiatal hernias using the Rampal–Narbona cardiorespexy technique and 16 patients who underwent laparoscopic Nissen– Rosetti fundoplication with cruroraphy. Cardioterespexy according to the Rampal-Narbona technique consists in the use of lig. Teres hepatis with the aim of forming the angle of His, fixing the cardiac part of the stomach and esophagus in the abdominal cavity. There were no cases of mortality. Complications after surgery were observed in older patients who were associated with concomitant pathology. The patients were examined within 10 to 18 months after surgery; in both groups, several cases of relapses and complications were recorded. In percentage terms, these data are as follows: during cardioterespexia surgery, the recurrence rate was 3.7%, signs of esophagitis were observed in 18%, cardia insufficiency was observed in 11.1%, signs of GER were in 11.1%, while in patients, of those operated on according to the Nissen–Rosetti technique, similar indicators were somewhat different: the percentage of relapse was 6.25%, signs of esophagitis were observed in 18.75%, cardiac insufficiency was observed in 18.75%, signs of GER were also in 18.75%. The results obtained indicate a good efficiency of cardiopexy with the round ligament of the liver, and a lower percentage of recurrence and complications in comparison with the Nissen– Rosetti technique (18.7%). The authors see the expediency of using the cardioterespexia technique in clinical practice both in the classical version and subject to its further improvement, which consists in increasing the mechanical properties of the round ligament of the liver and performing this operation by laparoscopic access.

Preoperative Diagnostic Difficulty of a Desmoid Tumor in the Ligamentum Teres Hepatis following Rectal Cancer Surgery—A Case Report—

Preoperative Diagnostic Difficulty of a Desmoid Tumor in the Ligamentum Teres Hepatis following Rectal Cancer Surgery—A Case Report—

Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

IntroductionPeritoneal metastases (PM) originating from colorectal cancer (CRC) and pseudomyxoma peritonei (PMP) can be treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Certain sites in the peritoneal cavity are prone to contain PM and are, therefore, routinely resected. The aim of this study is to investigate the frequency of disease in CRS specimens routinely resected. Secondly, to investigate if the risk of finding PM in routinely resected specimen is associated with involvement of anatomic related peritoneal areas. Materials and methodsThis study investigated 433 patients diagnosed with PMP (n = 119) or PM from CRC (n = 314) and operated with CRS + HIPEC between June 2006 and November 2020 at a national center. Baseline data were prospectively registered. Pathology reports were reviewed for the presence of metastases in the routinely resected umbilicus, ligamentum teres hepatis, ovaries and greater omentum. Tumor extent was estimated using the Dutch region count. ResultsPM was found in 14.7% of umbilical resections, in 17.4% of the resected ligamentum teres hepatis, in 48.2% of the resected ovaries and in 49.5% of the greater omentum specimens. We found an association between macroscopic disease involvement of the nearest region and risk of PM found in the related resections. Seven of 31 women with no macroscopically visible disease in the pelvis had PM diagnosed in the resected ovaries. ConclusionsA substantial proportion of routine resections held histologic verified PM. Our results may advocate for a routinely performed resection of the umbilicus, ligamentum teres hepatis, ovaries and greater omentum.

Use of the ligamentum teres hepatis for outflow reconstruction during ex vivo liver resection and autotransplantation in patients with hepatic alveolar echinococcosis: A case series of 24 patients

BackgroundPatients with extensive hepatic alveolar echinococcosis might require ex vivo liver resection and autotransplantation to remove the lesion. Patients with extensive vascular invasion will need reconstruction, but the selection of the proper graft is complicated. This study aimed to investigate the effectiveness and adverse events of using the ligamentum teres hepatis as a vascular replacement graft in ex vivo liver resection and autotransplantation. MethodsThis was a retrospective case series of patients with hepatic alveolar echinococcosis who underwent ex vivo liver resection and autotransplantation between August 2010 and October 2018 and in whom the ligamentum teres hepatis was used to repair the remnant liver. The operative outcomes, recurrence, and survival were examined. ResultsTwenty-four patients were included (10 men, 14 women). The anhepatic period was 290 to 672 minutes (median of 450 minutes). The ratio of the remnant liver volume to the standard liver volume was 0.43 to 0.97 (median of 0.71). The blood loss was 1,000 (500–5,000) mL. The postoperative hospital stay was 23 (1–85) days. Of the 24 patients, 3 died after the operation, but those deaths were unrelated to liver vascular complications. ConclusionThe ligamentum teres hepatis could be used as a vascular replacement graft in ex vivo liver resection and autotransplantation. It has the advantages of convenient specimen extraction, no donor site injury, and no immunological rejection, which has promising clinical application prospects.

Clear Cell Myo-Melanomas of Ligamentum Teres Hepatis: A Case Report and Literature Review

Introduction: Clear Cell Myomelanocytic Tumor (CCMMT) of ligamentum teres hepatis is a pathological classification of Perivascular Epithelioid Cell tumor (PEComa), which is rare clinically and easy to misdiagnose. Objective: To report a case of a rare type of PEComa located in the ligamentum teres hepatis. Case Report: A 22-year-old Asian female was diagnosed with abdominal mass during physical examination in September 2018, and was admitted to the general surgery department of our hospital that month. She was diagnosed with abdominal mass, the nature of which remains to be determined is: teratoma, pheochromocytoma or ganglioma. At the time of admission, the patient had no symptoms or signs, and no other medical history. The patient was diagnosed with an abdominal mass by abdominal plain scan and enhanced CT, whose nature was to be determined: pheochromocytoma, paragangliomas or other mesenchymal tumors, or giant lymph node hyperplasia. The patient underwent abdominal mass resection and appendectomy without incident, without any complications at discharge, and there was no significant difference in follow-up. Conclusions: The clinical data, imaging features and pathological features of one patient diagnosed with CCMMT in our hospital were retrospectively analyzed, and the literature was reviewed in combination with the research progress of CCMMT, in order to improve the understanding and diagnostic accuracy of this disease.

The New Interest of Bariatric Surgeons in the Old Ligamentum Teres Hepatis.

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 (6-36months). 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.

The Pedicled Teres Hepatis Ligament Flap Wrap Around the Gastroduodenal Artery Stump to Prevent Postoperative Hemorrhage after Laparoscopic Pancreatoduodenectomy (with Video)

To explore the feasibility and safety of teres hepatis ligament flap plasty around the gastroduodenal artery (GDA) stump to prevent postoperative hemorrhage after laparoscopic pancreatoduodenectomy (LPD). A total of 108 patients with GDA stump wrapped by pedicled teres hepatis ligament after LPD in our center were included for analysis from March 2018 to March 2019. After completion of LPD, teres hepatis ligament was dissected from the ventral abdominal cephalad along the ventral attachment, and the teres hepatis ligament was separated from the falciform ligament by ultrasonic scalpel or Ligasure. At the junction to the liver, the teres hepatis ligament is freed from the ventral hepatic surface. The junction between liver and teres hepatis ligament should not be cut off to ensure blood supply. Division of the GDA was performed using a Prolene 4-0 suture stitch or two clamps as a standard (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760602). The pedicled teres hepatis ligament then was used to completely cover the skeletonized GDA stump, and part of the common hepatic artery and the proper hepatic artery. The mobilized ligament can be transposed without tension. A total of 108 patients completed the procedure of GDA stump wrapped with pedicled teres hepatis ligament during LPD. There were no complications caused by GDA stump after operation. The main steps to wrap the GDA stump took an average of 10 min. Clinically relevant postoperative pancreatic fistula (CR-POPF) occurred in 8 cases (7.4%) (including 6 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula), and intra-abdominal infection in 8 cases (7.4%), including 3 cases (2.8%) of intra-abdominal abscess, postoperative gastrointestinal ulcer bleeding occurred in 2 cases (1.9%), and no intra-abdominal hemorrhage occurred. It is a safe and feasible procedure of wrapping GDA stump with pedicled teres hepatis ligament to prevent postoperative hemorrhage after LPD. The procedure is easy to perform without relevant additional surgical trauma or prolongation of the operation time.

A case of perihilar cholangiocarcinoma with bilateral ligamentum teres hepatis treated with hepatopancreatoduodenectomy

BackgroundBilateral ligamentum teres (BLT) hepatis is a very rare anomaly defined as the connection of the bilateral fetal umbilical veins to both sides of the paramedian trunk, and it has never been reported in the English literature.Case presentationA 72-year-old man who presented with obstructive jaundice was referred to our hospital. Contrast-enhanced computed tomography revealed that the patient had right-sided ligamentum teres (RSLT) and left-sided ligamentum teres (LSLT). The umbilical portion of the left portal vein, which the LSLT connected, became relatively atrophic in this patient. The RSLT attached to the tip of the right anterior pedicle and formed the umbilical portion of the right portal vein. The patient was diagnosed with perihilar cholangiocarcinoma which had invaded the root of the posterior branch of the bile duct, LHD, and intrapancreatic bile duct. The central bisectionectomy, in which the liver parenchyma was resected along the RHV on the right side and the LSLT on the left side, and caudate lobectomy combined with pancreatoduodenectomy were performed.The presence of the patient with BLT is important for ascertaining the mechanism of the development of RSLT. Two umbilical veins are present initially during the embryonic stage. In general, the right-sided vein disappears, and the atrophic left-sided vein remains connected to the left portal vein originating from the vitelline vein. Several papers on the mechanism of the development of RSLT have been published. Some authors have mentioned that a residue of the right umbilical vein and the disappearance of the left umbilical vein are the causes of RSLT. On the other hand, some authors have asserted that RSLT is the result of atrophy of the medial liver area. The presence of BLT in patients indicates that the mechanism of the development of RSLT is characterized by a residue of the right umbilical vein and the disappearance of the left umbilical vein.ConclusionsThe mechanism and origin of RSLT can be understood through cases of BLT, and surgeons must pay attention to anomalies of the portal and hepatic veins in patients with abnormal ligamentum teres.

Application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation

Objective To investigate the application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation. Methods The retrospective cohort study was conducted. The clinical data of 58 patients with recurrent hepatolithiasis who underwent laparoscopic biliary reoperation in the Chengdu Second People′s Hospital were collected. There were 33 males and 25 females, aged from 31 to 85 years, with an average age of 54 years. Thirty-one of 58 patients who underwent laparoscopic biliary reoperation using ligamentum teres hepatis approach were divided into the ligamentum teres hepatis group, and 27 patients who underwent laparoscopic biliary reoperation using regular anatomy and positioning were divided into the regular operation group. Observation indicators: (1) intraoperative situations; (2) postoperative recovery; (3) follow-up. Follow-up using telephone interview and outpatient examination was performed to detect the recurrence of bile duct stone up to August 2018. Doppler ultrasonography of biliary tract was performed once at 3, 6 and 12 months postoperatively and once at every 12 months after 1 year. Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed by rank sum test. Count data were analyzed using the four-grid table chi-square test or Fisher exact probability. Results (1) Intraoperative situations: all patients underwent successful laparoscopic biliary reoperation, without conversion to open surgery and perioperative death. During the intraoperative exploration, 7, 8, 16 patients in the ligamentum teres hepatis group and 5, 8, 14 patients in the regular operation group were respectively found peritoneal omental adhesions, hilar omental adhesions and hilar intestinal adhesions. The operation time and volume of intraoperative blood loss were (125±24)minutes, 40 mL(range, 15-100 mL) in the ligamentum teres hepatis group and (150±36)minutes, 55 mL(range, 20-350 mL) in the regular operation group, respectively, with statistically significant differences between the two groups (t=-3.162, Z=-2.768, P 0.05). Postoperative residual biliary calculi were removed by choledochoscope through T-tube sinus in outpatient department after 8-week carrying T-tube. (2) Postoperative recovery: the time to initial anal exsufflation and duration of postoperative hospital stay were respectively (31±7)hours, (7.2±1.5)days in the ligamentum teres hepatis group and (35±10)hours, (7.1±1.3)days in the regular operation group, with no statistically significant difference between the two groups (t=-1.814, 0.036, P>0.05). (3) Follow-up: 5 of 58 patients were lost to follow-up, including 3 in the ligamentum teres hepatis group and 2 in the regular operation group. Fifty-three patients were followed up for 6-40 months, with a median follow-up time of 28 months. No recurrence of bile duct stone was found in the ligamentum teres hepatis group. One patient in the regular operation group had recurrence of common bile duct stones at 36 months postoperatively and underwent endoscopic sphincterotomy stone. Conclusion Laparoscopic biliary reoperation for patients with recurrence of hepatolithiasis is a safe and effective method, and it can also quickly determine the location of common bile duct, with advantages of less blood loss and shorter operation time. Key words: Hepatolithiasis; Ligamentum teres hepatis approach; Surgical procedures, operative; Biliary reoperation; Laparoscopy

A case in which laparoscopic cholecystectomy was performed for acute cholecystitis with right ligamentum teres hepatis

A case in which laparoscopic cholecystectomy was performed for acute cholecystitis with right ligamentum teres hepatis

A common procedure with a rare anatomical finding: a case report on a true left-sided gallbladder

Left-sided gallbladders (LSG) are a rare group of congenital anomalies that are mainly discovered intraoperatively. The gallbladder can be situated on the left side in case of situs inverses or an abnormally right placed ligamentum teres hepatis. A true LSG (T-LSG) with no further congenital variation is a more infrequent presentation with a prevalence of 0.04–0.30%. We present a case report of a middle-aged woman with abdominal symptoms suggestive for cholecystolithiasis. While ultrasonography confirmed the diagnosis, it failed to diagnose the T-LSG preoperatively and thus no further imaging was performed. During the laparoscopic cholecystectomy the congenital anomaly was found but no surgical modifications were needed to guarantee an uneventful removal of the T-LSG. Postoperatively the patient was discharged the same day, no histological abnormalities were reported. Clinical symptoms in the case of a T-LSG do not differ from a normally positioned gallbladder; moreover, the variation is often missed on imaging. Upon finding a T-LSG intraoperatively surgeons can alter their port placement or patient positioning to ensure a better critical view of safety, we report a case in which these adjustments were not necessary to safely remove the gallbladder. However, surgeons should be aware of the altered biliary anatomy associated with T-LSG and adjust the procedure to their own preference in order to safely remove the gallbladder without the occurrence of intra- or postoperative complications.