Technical aspects - peritonealworkshop2008.comperitonealworkshop2008.com/docs/30_verwaal.pdfForamen Winslow Bursa omentalis Spleen Pancreas. Ileoceacal General heavy effected Easy

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 portahepatis and IVC

� Entrance to bursa

Winslow & Bursa

Bursa

Conclusion

It all comes down to knowing Anatomy

Thanks