J.Jpn. Surg. Soc.. 80(12): 1505-1509, 1979

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Report on the annual meeting

THE OPERATIVE PROCEDURE FOR THE THOROUGH DISSECTION OF HEPATIC PEDICLE, RETROPANCREATICODUODENAL AREAS AND AROUND THE COMMON HEPATIC ARTERY IN THE SURGICAL ERADICATION OF GASTRIC CARCINOMA (RETROMESENTERIC APPROACH)

For the surgical eradication of the gastric carcinoma which is located in the distal half of the stomach it is particularly important to include the regional lymphatics within the resection at the retropancreaticoduodenal areas, the hepatic pedicle and around the common hepatic artery as well as the other perigastric lymph drainage areas. However, we always find it difficult to dissect thoroughly these lymph drainage areas because the exposure of operative field at these portions is not enough.
Then, we added the complete mobilization of superior mesenteric system with right side colon and all of small intestine to conventional Kocher's duodenal mobilization by retroperitoneal incision at just lateral to the ascending colon and at the peritoneal reflection of small intestinal mesentery.
By this mobilization added, the retropancreaticoduodenal area is widely exposed in direct vision and the exposure of posterior surface of the hepatic pedicle (hepatoduodenal ligament) is accompanied. The posterior aspect of the common hepatic artery can also be in direct vision. This operative procedure seems to offer more wide operative field at the retropancreaticoduodenal areas, and is thought to be usefull for the thorough dissection of the hepatic pedicle, around the common hepatic artery, particularly of its posterior area, and the retropancreaticoduodenal areas.

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