The role of the left gastric vein in the preservation of the stomach during total duodenopancreatectomy in the modification of Botkin Hospital

Introduction. In total pancreatectomy, the main difficulty of stomach preservation was main vein preservation, especially the left gastric vein. The purpose of this study is to research all the variants of left gastric vein anatomy and prevention of its injuries while performing TP in the modification of the surgical clinic of Botkin Hospital.

Materials and methods. A retrospective analysis of the results of total pancreatectomy in patients with pancreatic tumors was carried out in the surgical clinic of Botkin Hospital from September 2007 to November 2022. During the development and implementation of pylorus-preserving total pancreatectomy with spleen preservation in the modification of Botkin Hospital, aspects of the venous anatomy of the stomach, mainly LGV affecting the possibility of performing the modification of TP, were analyzed.

Results. A total of 52 pancreatectomies were performed, including 27 pylorus-preserving total pancreatectomies. The most common LGV variant was Ip type, in which LGV passes behind the CHA. This anatomy variant of LGV was observed in 25 patients out of (48%). In 11 (21,2%) patients, LGV was damaged intraoperatively during total pancreatectomy. The incidence of LGV injury differed among variable anatomy types of LGV. As a rule, LGV passing posterior to any vessel was injured more often than the anterior types of LGV.

Conclusions. Knowledge of the anatomical variants of LGV, preoperative abdominal CT scan in order to inspect the course of LGV leads to prevention of intraoperative trauma of LGV and the increase in number of performed pylorus-preserving total pancreatectomies.

1. Stoop T. F., Ateeb Z., Ghorbani P., Scholten L. et al. Impact of endocrine and exocrine insufficiency on quality of life after total pancreatectomy. Annals of Surgical Oncology, 2020, Vol. 27, № 2, рр. 587–596. https://doi.org/10.1245/s10434-019-07853-3

2. Nanashima A., Hiyoshi M., Imamura N., Yano K. et al. Clinical significance of preoperative nutritional parameter and patient outcomes after pancreatectomy: A retrospective study at two academic institute. Annals of Hepato-biliary-pancreatic Surgery, 2019, Vol. 23, № 2, рр. 168–173, https://doi.org/10.14701/ahbps.2019.23.2.168

3. Yuasa Y., Okitsu H., Goto M., Kuramoto S. et al. Three–dimensional CT for preoperative detection of the left gastric artery and left gastric vein in laparoscopy – assisted distal gastrectomy. Asian journal of endoscopic surgery, 2016, Vol. 9, № 3, рр. 179–185. https://doi.org/10.1111/ases.12280

4. Natsume T., Shuto K., Yanagawa N., Akai T. et al. The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy. Surgical endoscopy, 2011, Vol. 25, № 5, рр. 1420–1424. https://doi.org/10.1007/s00464-010-1407-1

5. Zhu X., Zhao Q., Xiong W., Luo L., Zheng Y.et al. Anatomical observation and clinical significance of the left gastric vein in laparoscopic radical gastrectomy. Journal of Gastrointestinal Oncology, 2021, Vol. 12, № 4, рр. 1407. https://doi.org/10.21037/jgo-21-352

6. Kawasaki K., Kanaji S., Kobayashi I., Fujita T., Kominami H. et al. Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer. Gastric Cancer, 2010, Vol. 13, № 1, рр. 25–29. https://doi.org/10.1007/s10120-009-0530-y

7. Miyamoto R., Inagawa S., Nagai K., Maedaet M. et al. Three-dimensional reconstruction of vascular arrangement including the hepatic artery and left gastric vein during gastric surgery. Springerplus, 2016, Vol. 5, № 1, рр. 1–6. https://doi.org/10.1186/s40064-016-2583-9

8. Wu Y., Chen G., Wu P/ et al. CT imaging-based determination and classification of anatomic variations of left gastric vein. Surgical and Radiologic Anatomy, 2017, Vol. 39, № 3, рр. 249–255. 10.1007/s00276-016-1722-x

9. Iino I., Sakaguchi T., Kikuchi Y., Miyazaki S. et al. Usefulness of three-dimensional angiographic analysis of perigastric vessels before laparoscopic gastrectomy. Gastric Cancer, 2013, Vol. 16, № 3, рр. 355–361. https://doi.org/10.1007/s10120-012-0194-x

10. Miyaki A., Imamura K., Kobayashi R., Takamiet M. et al. Preoperative assessment of perigastric vascular anatomy by multidetector computed tomography angiogram for laparoscopy-assisted gastrectomy. Langenbeck’s archives of surgery, 2012, Vol. 397, № 6, рр. 945–950. https://doi.org/10.1007/s00423-012-0956-2

11. Kuwada K., Kuroda S., Kikuchi S., Hori N. et al. Strategic approach to concurrent aberrant left gastric vein and aberrant left hepatic artery in laparoscopic distal gastrectomy for early gastric cancer: A case report. Asian journal of endoscopic surgery, 2015, Vol. 8, № 4, рр. 454–456. https://doi.org/10.1111/ases.12203

12. Lee H., Lee J. Anatomic variations in the left gastric vein and their clinical significance during laparoscopic gastrectomy. Surgical Endoscopy, 2019, Vol. 33, № 6, рр. 1903–1909. https://doi.org/10.1007/s00464-0186470-z

13. Kimura K. Minagawa R., Izumi T., Otake A., Aoyagi T. et al. Ligation of Left Gastric Vein May Cause Delayed Gastric Emptying After Pancreatoduodenectomy: A Retrospective Study. BMC Gastroenterol, 2022, Aug 26; № 22(1), рр. 398 https://doi.org/10.1186/s12876-022-02478-5