A Patent Cranial End of the Ductus Venosus Can Result in Hemorrhage when Performing a Lesser Omentectomy-Omental Bursectomy Procedure.

BACKGROUND

In the surgical management of peritoneal metastases, a complete cytoreduction with all visible tumor removed is a necessary part of successful long-term management. One peritonectomy procedure that is occasionally accompanied by hemorrhage is the lesser omentectomy-omental bursectomy procedure. In the past, the cause of this unforeseen complication of cytoreductive surgery was not understood.

METHODS

The anatomy of the lesser omentectomy-omental bursectomy procedure was reviewed. The bleeding was determined to be originating from the superior aspect of the omental bursa and intimately associated with the left hepatic vein.

RESULTS

In performing this peritonectomy, it is necessary to clear the fissure defined by segments 2 and 3 of the liver with the left caudate lobe of the liver. This is the fissure defined by the ligamentum venosum. In dissecting the ligamentum venosum to its cranial end, this structure was found to be patent at its entrance into the left hepatic vein in some patients. Removal of the specimen requires transection of the ligamentum venosum as it enters the left hepatic vein. Transection of the ligament venosum at its cranial end can result in hemorrhage as a part of the lesser omentectomy-omental bursectomy procedure.

CONCLUSIONS

The ligamentum venosum should be identified within the fissure where it is anatomically located. As the specimen is removed from the superior aspect of the omental bursa, the attachments between the ligamentum venosum and the left hepatic vein should be ligated prior to the transection.