Perigastric vascular abnormalities and the impact on esophagogastrectomy

The surgeon's ability to recognize abnormal vascular anatomy has greater importance than ever in modern esophagogastric surgical procedures. Some aberrations of vascular vessels around the stomach found during extensive surgery due to primary cancer of the stomach, cardia and lower esophagus are presented in this paper. The purpose of the prospective study is to evaluate and classify these variations with respect to their impact in visceral surgery. A total of 426 patients who underwent total or extensive gastrectomy and esophagectomy combined with lymphadenectomy, have been analyzed prospectively. For the period of 10 years some vascular aberrations have been found in 54/426 (12.67%) of the patients in the operative field during lymphadenectomy as single or combined anomalies. An arterial perigastric anatomy considered normal in textbooks was found in 372 (87.32%) cases. An accessory left hepatic artery arising from the left gastric artery was found in 19/54 (35.18%), and replaced type in 7/54 (12.96%). The replaced right hepatic artery branching from the superior mesenteric artery was found in 5/54 (7.40%) cases. Replaced and accessory left gastric artery branching from the aorta was found in 8/54 (14.8%); accessory posterior gastric artery was found in 25/54 (44.4%), and abnormalities of the splenic, and subphrenic arteries were found in 6/54 (11.11%). Combined anomalies of both left and right hepatic arteries and variations of the celiac trunk were found in 2/54 (3.70%) cases. Forty-nine cases were classified according to established Michels' typology system. Six cases presented with extremely rare variations and remain unclassified. Possible intraoperative problems concerning postoperative complications are also emphasized.