Gastrophrenic Ligament

ligamentum gastrophrenicum

The gastrophrenic ligament connects the posterior fundus of the stomach to the inferior surface of the left diaphragm, transmitting the uppermost short gastric vessels. It is the most superior part of the greater omentum complex and must be divided to fully mobilise the gastric fundus for fundoplication, sleeve gastrectomy, and gastric bypass procedures requiring high posterior fundal access.

Region: Abdomen

Biomechanics

Function & Actions

Anchors the gastric fundus to the left diaphragm, limiting fundal ptosis, and transmits the highest short gastric vessels.

Clinical Relevance

Clinical Notes

Division of the gastrophrenic ligament is a key step in achieving adequate fundal mobilisation during Nissen fundoplication, where the fundus must be fully freed to create the wrap without tension. Inadequate division of this ligament is a common cause of wrap failure from tension-related slippage. In sleeve gastrectomy, the gastrophrenic ligament is divided to allow stapling of the fundus close to the oesophagogastric junction. The hepatogastric and gastrophrenic ligaments together define the lesser and posterior stomach attachments.

Pathology

Common Injuries & Conditions

Gastrophrenic Ligament Division in Fundoplication

Incomplete division of the gastrophrenic ligament during Nissen fundoplication leaves the gastric fundus tethered to the diaphragm, preventing complete fundal mobilisation and creating a tense wrap that causes dysphagia and has a higher rate of wrap disruption or slippage compared to fully mobilised wraps.