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The liver is an essential organ that occupies the right upper quadrant of the abdomen. This structure is supported by the hepatic veins, which open into the inferior vena cava, as well as by intraabdominal pressure and peritoneal ligaments. The liver is covered by visceral peritoneum, which reflects onto adjacent viscerae and the abdominal wall as peritoneal ligaments. The falciform ligament is a bilayered, sickle-shaped fold of parietal peritoneum that extends from the anterior abdominal wall to the inferior border and anterior surface of the liver. This fibrous band serves as a crucial landmark during minimally invasive and laparoscopic abdominal procedures. This ligament may also be used as a patch or flap for reconstruction or repair of nearby structures. During surgery, the falciform may be seen drooping from the liver hilum. The structure attaches to the liver between the right and left lobes and to the inferior diaphragmatic surface. The ligament's free, inferior border contains the paraumbilical veins and the round ligament of the liver (ligamentum teres hepatis), which runs along a fissure between the inferior surfaces of the right and left lobes. To avoid confusion, the shorthand “round ligament” here refers specifically to the round ligament of the liver, not the round ligament of the uterus. The paraumbilical veins become more prominent and patent in portal hypertension, when the portal vein is engorged with blood that cannot fully enter the liver. If severe, these veins form a caput medusae—engorged vessels surrounding the umbilicus. Caput medusae is a hallmark of portal hypertension and advanced liver dysfunction, as seen in end-stage liver disease.