Thilo Hackert, MD, Vladimir J

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Teres Hepatis Ligament Flap Plasty to Prevent Pancreatic Fistula after Tumor Enucleation Thilo Hackert, MD, Vladimir J. Lozanovski, MD, Jens Werner, MD, MBA, Markus W. Büchler, MD, Peter Schemmer, MD, MBA Journal of the American College of Surgeons Volume 217, Issue 4, Pages e29-e34 (October 2013) DOI: 10.1016/j.jamcollsurg.2013.06.014 Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 1 Situs prior to complete tumor enucleation of a pancreatic tumor lesion localized in the pancreatic body. Journal of the American College of Surgeons 2013 217, e29-e34DOI: (10.1016/j.jamcollsurg.2013.06.014) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 2 Tumor bed after tumor enucleation. Blood coagulation is achieved by clipping and thermocoagulation. Journal of the American College of Surgeons 2013 217, e29-e34DOI: (10.1016/j.jamcollsurg.2013.06.014) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 3 Closure of parenchyma and capsule using atraumatic sutures. Journal of the American College of Surgeons 2013 217, e29-e34DOI: (10.1016/j.jamcollsurg.2013.06.014) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 4 Tumor specimen of a well-differentiated endocrine pancreatic tumor with a diameter of 1.6 cm enucleated in sano. Journal of the American College of Surgeons 2013 217, e29-e34DOI: (10.1016/j.jamcollsurg.2013.06.014) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 5 The skeletonized teres hepatis ligament pedicle flap is sufficiently mobilized and guided through a window in the lesser omentum (retrogastrally) toward the pancreatic tissue defect. Journal of the American College of Surgeons 2013 217, e29-e34DOI: (10.1016/j.jamcollsurg.2013.06.014) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 6 Teres hepatis ligament transposed on the previously closed enucleation site and fixated with atraumatic suture. Journal of the American College of Surgeons 2013 217, e29-e34DOI: (10.1016/j.jamcollsurg.2013.06.014) Copyright © 2013 American College of Surgeons Terms and Conditions