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Ligamentum Hepatogastricum – Anatomy and Function

The ligamentum hepatogastricum is a peritoneal fold connecting the liver to the lesser curvature of the stomach, forming the left portion of the lesser omentum.

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Things worth knowing about "Ligamentum hepatogastricum"

The ligamentum hepatogastricum is a peritoneal fold connecting the liver to the lesser curvature of the stomach, forming the left portion of the lesser omentum.

Definition and Anatomy

The ligamentum hepatogastricum (hepatogastric ligament) is a peritoneal fold that connects the visceral surface of the liver (facies visceralis hepatis) to the lesser curvature of the stomach (curvatura minor gastrica). It forms the larger, left portion of the lesser omentum (omentum minus) and is continuous on the right with the narrower ligamentum hepatoduodenale, which carries the portal vein, hepatic artery, and common bile duct within its free edge.

Together, the ligamentum hepatogastricum and the ligamentum hepatoduodenale constitute the complete lesser omentum, serving as a connecting structure between the liver, stomach, and duodenum.

Structure and Contents

The ligamentum hepatogastricum consists of two peritoneal layers and typically contains the following structures:

Anterior and posterior gastric branches of the vagus nerve, supplying the stomach
Hepatic branches of the vagus nerve
Small blood vessels and lymphatics, including branches of the left gastric artery (arteria gastrica sinistra) and accompanying veins and lymph capillaries

The space posterior to the lesser omentum is known as the bursa omentalis (omental bursa or lesser sac), an important anatomical cavity in the upper abdomen.

Function

The ligamentum hepatogastricum serves several important functions:

Mechanical support: It anchors the stomach to the liver, maintaining the stomach in its anatomical position.
Conduit for vessels and nerves: It acts as a pathway for blood vessels, nerves, and lymphatic channels connecting the stomach and liver.
Boundary of the omental bursa: It forms the anterior wall of the lesser sac, separating it from the greater peritoneal cavity.

Clinical Relevance

The ligamentum hepatogastricum holds significant importance in clinical medicine and surgery:

Surgical Access

During upper abdominal surgery -- such as gastric resection, liver operations, or surgical treatment of peptic ulcers -- the ligamentum hepatogastricum often needs to be divided or dissected to gain access to the omental bursa or the structures behind it, including the pancreas and aorta.

Tumor Infiltration

In gastric carcinoma or liver tumors, the ligamentum hepatogastricum may be infiltrated by tumor tissue. This is an important consideration during surgical resection and tumor staging.

Inflammatory Conditions

Inflammation of the stomach or liver -- such as peptic ulcer disease, cholecystitis, or pancreatitis -- can extend into the ligamentum hepatogastricum, leading to thickening, adhesions, or abscess formation within or around this structure.

Laparoscopic Surgery

In minimally invasive (laparoscopic) surgery, a thorough understanding of the anatomy of the ligamentum hepatogastricum is essential to avoid injury to critical structures such as the vagus nerve or the left gastric artery.

Embryology

From a developmental perspective, the ligamentum hepatogastricum arises from the ventral mesogastrium, a peritoneal fold that forms between the foregut and the anterior abdominal wall during embryonic development. The liver bud grows into this mesogastrium and divides it into the future ligamentum hepatogastricum (toward the stomach) and the ligamentum falciforme hepatis (toward the anterior abdominal wall).

References

Standring, S. (Ed.): Gray's Anatomy. 41st Edition. Elsevier, 2015.
Drake, R.L., Vogl, A.W., Mitchell, A.W.M.: Gray's Atlas of Anatomy. 3rd Edition. Elsevier, 2019.
Moore, K.L., Dalley, A.F., Agur, A.M.R.: Clinically Oriented Anatomy. 8th Edition. Lippincott Williams and Wilkins, 2017.

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