Technical aspects - pe Winslow Bursa omentalis Spleen Pancreas. Ileoceacal General heavy effected...

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Transcript of Technical aspects - pe Winslow Bursa omentalis Spleen Pancreas. Ileoceacal General heavy effected...

  • Upper adbomen

    Technical aspects

  • Mesenteric disease

    � Introduction

    � Definition of regions • In scorings systems

    � Number of effection � Number of failure

    � Anatomic considerations � Recurrences

  • Context

    � Most HIPEC surgeon are lower GI surgeons.

    � The upper abdomen is an interesting place.

    � Hidden corners and caves � Import structures to damage � There can be heroic successes.

  • 7 region system

    � Pelvis � Ileoceacal � Omentum / colontransversum � Small bowel � Sub hepatic � Sub phrenic left � Sub phrentic right

  • Effected regions

    15

    11

    16

    25

    26

    20

    36

    2

    101463Subphrenic L

    121953Subphrenic R

    91955Subhepatic

    83631Small bowel

    213122Omentum

    122742Ileoceacal

    282511Pelvis

    310

  • Effected after cytoreduction (%)

    1

    0

    5

    3

    2

    1

    1

    2

    11187Sub phrenic L

    21681Sub phrenic R

    11974Subhepatic

    12075Small bowel

    11384Omentum

    0692Ileocoecal

    1888Pelvis

    310Post

  • Regions cleared (%)

    2

    1

    11

    4

    2

    30

    1

    2

    33166Subphrenic L

    33560Subphrenic R

    34344Subhepatic

    22964Small bowel

    11680Omentum

    183021Ileocoecal

    11087Pelvis

    310∆

  • Suvival related to regions

    � Small bowel most determinating to survival.

  • Typical & problem site’s

    � Terminal ileum � Ligament Treits � Foramen Winslow � Bursa omentalis � Spleen � Pancreas

  • Ileoceacal

    � General heavy effected � Easy resectable � The easy way to start any exploration of

    the abdomen. � The to find the access to pelvis and

    upper abdomen.

  • Terminal ileum

  • Treits ligament

    � Outer side of the duodenum � Left colic vein � Easy accumulation

  • Treitz erea

  • Winslow

    � Between porta hepatis and IVC

    � Entrance to bursa

  • Winslow & Bursa

  • Bursa

  • Conclusion

    It all comes down to knowing Anatomy

  • Thanks