Three Surgical Approaches of Laparoscopic Splenic Flexure Mobilization

Splenic flexure mobilization during laparoscopic colorectal surgery, which is used for elongation of the remaining colon after resecting the left colon or rectum, is sometimes essential for making a secure anastomosis without tension. However, laparoscopic splenic flexure mobilization is often time consuming and technically demanding, particularly in obese patients with severe adhesion. Therefore, three surgical approaches are introduced to make the procedure easier according to the method of entering the lesser sac: anterior approach, inferio-medial approach, and lateral approach.

Malignant Fibrous Histiocytoma Originating in the Lesser Sac

A malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. About 70% of tumors arise from the soft tissue of the extremities with only 12~14% of the tumors occur in the retroperitoneum. The clinical characteristics of this tumor consist of an abdominal mass, tendency for local recurrence, paraneoplastic syndrome and a poor prognosis. A 51-year-old woman was admitted to St. Vincent's Hospital with complaining of fever and an abdominal mass. Ultrasound and computed tomography revealed a huge, heterogenous mass in the lesser sac area. The patient underwent an extensive mass resection with a histologic examination revealing a MFH which was positive for alpha1- antitrypsin. We report a case of MFH presenting in the lesser sac with a review of the literatures.

The value of CT in localizing primary and stomach-originated masses in the lesser sac / 中华放射学杂志

Objective To investigate the normal CT manifestation of the vascular arch of the gastric lesser curvature,and to further probe the value of CT in the localization diagnosis of the primary and stomach-originated masses in the lesser sac.Methods Contrast-enhanced CT scanning was performed in 51 normal individuals.Emphasis of image observation was focused on the CT manifestations of vascular arch of the gastric lesser curvature and the relation between the vascular arch and the gastric wall.Also contrast- enhanced CT scan was performed for seventeen cases of primary and stomach-originated masses in the lesser sac subsequently proved by surgery and pathology.Image analysis was focused on the relation between the mass and the vascular arch and its branches of the gastric lesser curvature,the shape of the mass,and the relation between the mass and the gastric wall.Results The vascular arch of the gastric lesser curvature was clearly visualized in the fifty normal individuals.The tributaries of the vascular arch near the cardiac part,gastric corpus,and pyloric part were revealed in 42,10 and 7 cases respectively.The vascular arch was in close contact with the gastric wall in 38 cases.Among the 17 patients,13 cases demonstrated the obliteration of the transparent fat plane between the mass and the gastric wall.In 6 patients with stomach- originated masses,5 patients showed the stretching of vascular arch tributaries adjacent to the masses,and no vascular arch and its tributaries could be not visualized between the masses and the stomach.In 11 patients with primary masses in the lesser sac,vascular arch were showed between the masses and the stomach in 10 cases,and no stretching of vascular arch tributaries adjacent to the masses could be showed.Conelusions CT scan can clearly depict the normal vascular arch and its branches of the gastric lesser curvature.Based on the relation between the vascular arch and the gastric wall,the presence of fat between the masses and the gastric wall and the shape of the masses,it is possible to differentiate accurately the primary lesser sac masses from those of stomach origin.