The ligamentum teres hepatis (round ligament of the liver) is the fibrous remnant of the left umbilical vein, running in the free inferior border of the falciform ligament from the umbilicus to the inferior surface of the left hepatic lobe at the umbilical notch, where it enters the fissure for the ligamentum teres and connects to the left branch of the portal vein.
A fibrous remnant of the umbilical vein with no functional role in adults; serves as a surgical landmark between the left hepatic lobe segments II/III and IV and as a source of recanalisation in portal hypertension.
The ligamentum teres is a critical landmark in hepatic surgery, defining the line between the left lateral section (segments II/III) and the left medial section (segment IV). In left lateral sectionectomy, the ligamentum teres is ligated and divided to enter the hepatic parenchyma along the intersegmental plane. In severe portal hypertension, the ligamentum teres can recanalise as a patent paraumbilical vein, decompressing the portal system via the umbilicus, producing a caput medusae. It is used as a biliary interposition graft in some choledochoplasty procedures.
Recanalisation of the ligamentum teres as a patent paraumbilical vein occurs when portal pressure exceeds systemic in severe portal hypertension, producing dilated superficial veins radiating from the umbilicus that form the caput medusae, a clinical sign of significant portal hypertension with associated splenomegaly and varices.
