Technical aspects - peritonealworkshop2008.comperitonealworkshop2008.com/docs/30_verwaal.pdfForamen...
Transcript of Technical aspects - peritonealworkshop2008.comperitonealworkshop2008.com/docs/30_verwaal.pdfForamen...
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Upper adbomen
Technical aspects
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Mesenteric disease
� Introduction
� Definition of regions• In scorings systems
� Number of effection� Number of failure
� Anatomic considerations� Recurrences
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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.
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7 region system
� Pelvis� Ileoceacal� Omentum / colontransversum� Small bowel� Sub hepatic� Sub phrenic left� Sub phrentic right
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Effected regions
15
11
16
25
26
20
36
2
101463Subphrenic L
121953Subphrenic R
91955Subhepatic
83631Small bowel
213122Omentum
122742Ileoceacal
282511Pelvis
310
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Effected after cytoreduction (%)
1
0
5
3
2
1
1
2
11187Sub phrenic L
21681Sub phrenic R
11974Subhepatic
12075Small bowel
11384Omentum
0692Ileocoecal
1888Pelvis
310Post
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Regions cleared (%)
2
1
11
4
2
30
1
2
33166Subphrenic L
33560Subphrenic R
34344Subhepatic
22964Small bowel
11680Omentum
183021Ileocoecal
11087Pelvis
310∆
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Suvival related to regions
� Small bowel most determinating to survival.
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Typical & problem site’s
� Terminal ileum� Ligament Treits� Foramen Winslow� Bursa omentalis� Spleen� Pancreas
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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.
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Terminal ileum
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Treits ligament
� Outer side of the duodenum� Left colic vein� Easy accumulation
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Treitz erea
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Winslow
� Between portahepatis and IVC
� Entrance to bursa
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Winslow & Bursa
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Bursa
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Conclusion
It all comes down to knowing Anatomy
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Thanks