Use of the Falciform Ligament as a Vascularised Flap in Abdominal Surgery: A Systematic Review

Background: The falciform ligament has been increasingly used as a vascularised pedicled flap in various abdominal surgical procedures, including hepatobiliary, upper gastrointestinal, and emergency surgery. However, evidence regarding its indications, techniques, and outcomes remains scattered and heterogeneous. Objective : To systematically review the indications, surgical techniques, and postoperative outcomes associated with the use of the falciform or round ligament as a vascularised flap in abdominal surgery. Methods: This systematic review will be conducted in accordance with the PRISMA 2020 guidelines. Eligibility Criteria: Inclusion criteria will include original studies involving adult patients (≥18 years) undergoing abdominal surgery in which the falciform ligament or round ligament was used as a vascularised pedicled flap or patch. Randomized controlled trials, cohort studies, retrospective studies, and case series with five or more patients will be included. Exclusion criteria will include case reports, review articles, editorials, pediatric studies, non-English language articles, and purely anatomical or experimental studies. Information Sources: A comprehensive search will be conducted in PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library. Search Strategy: Search terms will include combinations of keywords and MeSH terms such as “falciform ligament”, “round ligament”, “flap”, “patch”, and “abdominal surgery”. Study Selection: Two reviewers will independently screen titles and abstracts, followed by full-text assessment for eligibility. Discrepancies will be resolved by consensus. Data Extraction: Data will be extracted using a standardized data collection form, including study characteristics, surgical indication, type of procedure, number of patients, outcomes, and complications. Risk of Bias Assessment: The methodological quality of included studies will be assessed using the Newcastle–Ottawa Scale for cohort studies and the Joanna Briggs Institute (JBI) checklist for case series. Data Synthesis: A narrative synthesis of results will be performed. Meta-analysis will be conducted if sufficient homogeneity of data is identified.