The lesser omentum (gastrohepatic and hepatoduodenal ligaments) creates a peritoneal fold space between the stomach and the liver, forming the anterior wall of the lesser sac and containing the portal triad structures in its free edge. The hepatoduodenal ligament free edge contains the portal vein, hepatic artery, and common bile duct.
The lesser omental free edge is the site of the Pringle manoeuvre — digital compression of the hepatoduodenal ligament to control hepatic inflow during liver surgery. Portal hypertension distends the portal vein within the lesser omental free edge. In liver transplantation, the hepatoduodenal structures within the lesser omental free edge are anastomosed in sequence. Cholangiocarcinoma at the hepatic hilum involves the lesser omental contents.
Digital or clamp compression of the lesser omental free edge containing the portal triad to reduce hepatic inflow during liver surgery, safe for up to 60 minutes of ischaemia in a non-cirrhotic liver.
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