Anatomic basis of venous drainage in gastric tubular esophagoplasty

This study was made with the aim of specifying the general architecture of the venous system of the stomach and its mode of drainage under normal conditions, and also of investigating the role of the venous drainage in the origin of disunion, anastomotic fistula and structure after tubular esophagoplasty pedicled on the right gastroepiploic vessels. Sixty stomachs removed from fresh cadavers were studied by injection-corrosion, using colored Altufix P10 as the injection mass. 35 specimens were injected globally via the superior mesenteric v., 15 by the same route but after clamping of the splenic, left gastric and right gastric vv., which corresponds to the technique of gastrolysis performed in esophagoplasty, and 10 were injected simultaneously with media of four different colors via the left gastric, right gastric, superior mesenteric and splenic vv. to define their respective territories. Also studied were the origin, course, termination, territory and caliber of the main gastric veins. Analysis of the results confirmed the richness of the venous anastomoses of the stomach, effected on the one hand between the two extraparietal arches at the greater and lesser curvatures, and on the other by intraperitoneal communications arranged perpendicular to these two arches. It emerges that the right gastroepiploic v. cannot always ensure drainage of the entire stomach. The factors involved are discussed. The risk of venous stasis in gastric esophagoplasty must always be borne in mind.