The hepatogastric ligament is the larger and thinner portion of the lesser omentum, extending from the porta hepatis and the fissure for the ligamentum venosum downward to the lesser curvature of the stomach. It is continuous on its right with the hepatoduodenal ligament and contains the right and left gastric vessels running along the lesser curvature.
| Origin | Fissure for the ligamentum venosum and porta hepatis of the liver |
|---|---|
| Insertion | Lesser curvature of the stomach |
Connects the lesser curvature of the stomach to the liver, transmits the gastric blood supply and lymphatics along the lesser curvature, and forms part of the anterior wall of the lesser sac.
Division of the hepatogastric ligament (pars flaccida) is a common way into the lesser sac during gastrectomy, fundoplication, and distal pancreatectomy. Replaced or accessory left hepatic arteries from the left gastric artery commonly course through this structure and must be identified before division. The left gastric (coronary) vein running in it is a major portosystemic collateral feeding oesophageal varices in portal hypertension. A foramen of Winslow hernia (rare internal hernia) allows bowel to enter the lesser sac behind the free edge of the lesser omentum, producing closed-loop obstruction requiring urgent surgery.
Herniation of small bowel or right colon through the epiploic foramen into the lesser sac produces closed-loop intestinal obstruction with a characteristic right-sided cluster of bowel loops on CT, requiring urgent surgical reduction.
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