Greater Curvature of the Stomach
Gastrosplenic (Gastrolienal) Ligament
The Greater Omentum connects the stomach, spleen, and indirectly, the liver to the posterior body wall. The designation omentum, ligament, or mesentery, simply indicates two layers of peritoneum suspending different organs. The local parts of the greater omentum can be designated as the Gastrolienal Ligament, between the Greater Curvature of the Stomach and the Spleen, and the Gastrophrenic Ligament, from the stomach to the diaphragm. The inferior extension of the greater omentum becomes the Gastrocolic Ligament. The gastrocolic ligament is continuous with the transverse mesocolon.
One of the most common problems requiring surgical entry into the lesser sac is an ulcer of the posterior wall of the stomach. By incising one of the mesenteries that bound the lesser sac, the surgeon can gain more working space. But these mesenteries are not equally suitable as sites for such an incision.
Incision of the gastrohepatic part of the lesser omentum provides neither a sufficient view nor mobilization of the stomach.
Incision of the lienorenal ligament is contraindicated by the fact that the tail of the pancreas and splenic vessels run in this ligament perpendicular to the path of the incision.
Entrance to the lesser sac by cutting through the gastrosplenic ligament is contraindicated by the fact that the short gastric and left gastroomental vessels run in this ligament perpendicular to the path of the incision.
Transverse incision of the transverse mesocolon would allow wide access to the lesser sac, but would cut through the middle colic vessels.
The preferred method of
entry to the the lesser sac is a transverse incision through the gastrocolic
ligament. Within this ligament run the gastroomental vessels, but they course
parallel to the incision, not perpendicular to it.