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By Manish A. Shah

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C) Multiple nodular type small bowel and its mesenteric involvement. (d) Conglomerated type small bowel and its mesenteric involvement. (e) Scar type small bowel and its mesenteric involvement. 2 Detection Method and Peritonectomy Techniques to Remove Peritoneal Metastases on the Small Bowel The entire small bowel and its mesentery are traced from the duodenojejunal flexure to the ileocecal junction. There are often tumour nodules at paraduodenal recesses covering the ligament of Treitz, and these are easily dissected by aqua dissection technique [4].

Both this hepatic bridge and umblical ligament are prone for cancer cells invasion. Cancer nodules in the fissure are electroevaporated and peritoneum is peeled off from this site with caution not to damage left hepatic artery or it’s branch. Some patients, a bridge of liver (hepatic bridge) is covered by parenchyma and creates a tunnel around ligamentum teres. This tunnel is lined by peritoneum and may be seeded by tumour. This parenchymal bridge is divided by electrosurgery. Then the tumour nodules are electroevaporated from the fissure and the peritoneum is stripped away.

1 23 dissection of parietal peritoneum is indicated if tumour nodules observed in parietal peritoneum in order to achieve complete cytoreduction (Fig. 6). Dissection between the peritoneum and the transversalis fascia is continued in lower abdomen. Broad and tight traction is essential for stripping of parietal peritoneum in paracolic areas (Fig. 7). Total Anterior Parietal Peritonectomy Peritonectomy procedures are facilitated by a self retaining retractor. For good exposure of the parietal peritoneum, stay silk sutures are used to anchor the edges of the skin and linea alba to the retractor.

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