Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine.
S.M. Kirov Military-Medical Academy
Saint-Petersburg University
Brief summary
The analysis of foreign literature on variant anatomy of the left gastric vein is presented, in particular typical and atypical patterns of its confluence, topography, morphometric characteristics and clinical significance of anatomical features in surgery. The issues under consideration are important for clinical practice, in particular, for surgical treatment of the syndrome of portal hypertension and other diseases of the gastrosplenopancreatoduodenal zone. It is shown that the left gastric vein enters the portal vein with a frequency of up to 66.8%, into the splenic vein - up to 33.2% and approximately 1% - directly to the lobar vein of the liver or its parenchyma. The range of the diameter of the left gastric vein is also characterized by variability, which is associated with various variants of topography and the presence of the right gastric vein. The frequency of the different variants of the left gastric vein entrances and the morphometric indices, apparently, depends on the size of the sample of the studied objects, sex and other causes. Clinical examples are presented that demonstrate the need for an on-site examination of the pattern of the left gastric vein entrance and its morphometric features in operative and diagnostic manipulations in the area of the upper floor of the peritoneal cavity. Without an accurate knowledge of the architectonics of the left gastric vein, there is a high risk of damage to it, which can lead to a decrease in the quality of surgical intervention and serious complications. It has been established that a universal, simplest in practice classification of variants of the left gastric vein entrance, as well as an explanation of the causes of its atypical variants and the technique of their prediction, are not yet available.
1. Horonko U.V., Dmitriev A.V., Chymbyridze I.P., Sarkisov A.E. Operaciya TIPS/TIPS i embolizaciya levoi jelydochnoi veni v lechenii varikoznih krovotechenii portalnogo geneza // Fyndamentalnie issledovaniya. - 2014. - N 10. - S. 575-580.
2. Deneve E., Caty L., Fontaine C., Guillem P. Simultaneous aberrant left and right gastric veins draining directly into the liver // Ann. Anat. - 2003. - Vol. 185. - P. 263-266.
3. Didio L.J.A. The termination of the vena gastrica sinistra in 220 cadavers // Anat. Rec. - 1961. - Vol. 141. - P. 141-144.
4. Douglass B.E., Baggenstoss A.H., Hollinshead W.H. The anatomy of the portal vein and its tributaries // Surg. Gynecol. Obstet. - 1950. - Vol. 91. - P. 562-576.
5. Hans S.S., Koukhab M., Hans B. Anterolateral left gastric (coronary) vein: an anatomical variant // Gastrointest. Radiol. - 1985. - Vol. 10, N 4. - P. 347-378.
6. Huang C.M., Wang J.B., Wang Y. et al. Left gastric vein on the dorsal side of the splenic artery: a rare anatomic variant revealed during gastric surgery // Surg. Radiol. Anat. - 2014. - Vol. 36. - P. 173.
7. Ishikawa T., Ushiki T., Mizuno K. et al. CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices // World J. Gastroenterol. - 2005. - Vol. 11. - P. 7515-7519.
8. Kawasaki K., Kanaji S., Kobayashi I. et al. Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer // Gastric Cancer. - 2010. - Vol. 13, N 1. - P. 25-29.
9. Kodama H., Aikata H., Takaki S. et al. Evaluation of portosystemic collaterals by mdct-mpr imaging for management of hemorrhagic esophageal varices // Eur. J. Radiol. - 2010. - Vol. 76. - P. 239-245.
10. Kubik S., Groscurth P. Eine seltene anomalie der extrahepatischen gallenwege und der V. coronaria ventriculi // Chirurg. - 1977. - Vol. 48. - P. 77-80.
11. Kuwada K., Kuroda S., Kikuchi S. et al. Concurrent ALGV and ALHA // Asian J. Endosc. Surg. - 2015. - Vol. 8. - P. 454-456.
12. Lee J., Kim W. Long-term outcomes after laparoscopy assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences // J. Surg. Oncol. - 2009. - Vol. 100. - P. 693-698.
13. Lee Ju-Hee, Sang-Hoon Ahn, Do Joong Park et al. Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer // World J. Surg.- 2012. - Vol. 36. - P. 2394-2399.
14. Lee M.S., Lee J.H., Park D.J. et al. Comparison of short- and long-term outcomes of laparoscopic assisted total gastrectomy and open total gastrectomy in gastric cancer patients // Surg. Endosc. - 2013. - Vol. 27. - P. 2598-2605.
15. Lee S.W., Shinohara H., Matsuki M. et al. Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery // J. Am. Coll. Surg. - 2003. - Vol. 197, N 6. - P. 927-936.
16. Li C.Y., Gao B.L., Song B. et al. Evaluation of left gastric vein in Chinese healthy adults with multi-detector computed tomography // Postgraduate Medicine. - 2016. - Vol. 128, N 7. - P. 701-705.
17. Matsuki M., Kani H., Tatsugami F. et al. Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy // Am. J. Roentgenol. - 2004. - Vol. 183. - P. 145-151.
18. Matsumoto A., Kitamoto M., Imamura M. et al. Three-dimensional portography using multislice helical CT is clinically useful for management of gastric fundic varices // Am. J. Roentgenol. - 2001. - Vol. 176. - P. 899-905.
19. Matsuki M., Tanikake M., Kani H. et al. Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy // Am. J. Roentgenol. - 2006. - Vol. 186. - P. 1079-1085.
20. Miyaki T., Yamada M., Kumaki K. Aberrant course of the left gastric vein in the human: possibility of a persistent left portal vein // Acta Anat. - 1987. - Vol. 130. - P. 275-279.
21. Mutter D., Marescaux J. Gastrectomies pour cancer: principles generaux, anatomie vasculaire, anatomie lymphatique, curages // Encycl. Med. Chir. - 2001. - Vol. 1. - P. 40-330.
22. Ohashi I., Ina H., Hanafusa K. et al. Aberrant left gastric vein demonstrated by helical CT // J. Comput. Assoc. Tomog. - 1997. - Vol. 21. - P. 996-1000.
23. Ohkubo M. Aberrant left gastric vein directly draining into the liver // Clin. Anat. - 2000. - Vol. 13. - P. 134-137.
24. Rebibo L., Chivot C., Fuks D. et al. Three-dimensional computed tomography analysis of the left gastric vein in a pancreatectomy HPB // The Official Journal of the International Hepato Pancreato Biliary Association. - 2012- Vol.14, N 6. - P. 414-421.
25. Roi D.J. Ultrasound anatomy of the left gastric vein // Clin. Radiol. - 1993. - Vol. 47. - P. 396-398.
26. Shoichi M., Hideaki M. To-and-fro wave-forms in the left gastric vein in portal hypertension // J. Med. Ultrason. - 2012. - Vol. 39. - P. 101-104.
27. Shuang J., Qi S., Zheng J. et al. A case-control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer // J. Gastrointest. Surg. - 2011. - Vol. 15. - P. 57-62.
28. Tajima H., Murakami R., Kumazaki T. Aberrant left gastric vein directly draining into left portal venous system: a case report // Acta Radiol. - 1992. - Vol. 33. - P. 462-463.
29. Takiguchi S., Sekimoto M., Fujiwara Y. et al. Laparoscopic lymph node dissection for gastric cancer with intraoperative navigation using three-dimensional angio computed tomography images reconstructed as laparoscopic view // Surg. Endosc. - 2004. - Vol. 18. - P. 106-110.
30. Uyama I., Sugioka A., Fujita J. et al. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer // Gastric Cancer. - 1999. - Vol. 2, N 4. - P. 230-234.
31. Walcker F.J. Beitraege zur chirurgischen Anatomie des Pfortader-systems // Dtsch. Z. Chir. - 1922. - Vol. 168. - P. 354-408.
32. Wang Y., Huang C.M., Zheng C.H. et al. Classification of anatomic variations in the left gastric vein during laparoscopic gastrectomy //Anat. Physiol. - 2013. - Vol. 3. - P. 127.
33. Widrich W.C., Srinivasan M., Semine M.C., Robbins A.H. Collateral pathways of the left gastric vein in portal hypertension // Am. J. Roentgenol. - 1984. - Vol. 142. - P. 375-382.
34. Zhao L.Q., He W., Chen G. Characteristics of paraesophageal varices: a study with 64-row multidetector computed tomography portal venography // World J. Gastroenterol. -2008. - Vol. 14. - P. 5331-5335.