Relevance of Posterior Gastric Vessel in Bariatric Surgery
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Relevance of Posterior Gastric Vessel in Bariatric Surgery Prakhar Gupta 1 & Shivanshu Misra 1 & S. Saravana Kumar 1 & P. Praveen Raj 1 Received: 7 June 2020 / Revised: 20 August 2020 / Accepted: 20 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Posterior gastric vessel is commonly encountered (4–99%) during surgery of the stomach, spleen, and pancreas. Due to high variations in its origin, and course, it has not been unanimously described in literature. Its significance in bariatric surgery is largely neglected. We reviewed videos of 100 bariatric surgery cases done in our institute. This vessel was noted in 88 cases. We could identify the vessel in 54/63 LSG cases and all cases required division to free the fundus. It was identified in 34/37 RYGB cases. Thirty-one cases required lateralization while 3 cases required division due to more medial origin of the vessel. Its division or lateralization facilitates adequate mobilization of fundus to achieve the ideal configuration of sleeve in LSG and pouch in LRYGB. Keywords Posterior gastric vessel . Retrogastric vessel . Laparoscopic sleeve gastrectomy . Laparoscopic Roux-en-Y gastric bypass
Introduction The anatomy of the posterior gastric artery, though being described in cadaveric studies for three centuries, has not been unanimously agreed upon. Its incidence has been reported to be around 4–99% by various authors. Moreover, its high incidence, variable, and deep course and highly variable distribution make it an important structure while operating on the stomach, pancreas, spleen, and celiac region. [1–3] Bariatric surgery is now being done worldwide for morbid obesity with laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) being the most commonly performed surgeries. These surgeries being done laparoscopically make the correct knowledge of this vessel even more critical for better fundal mobilization. Also,
bleeding from this vessel can cause loss of plane and difficulty in hemostasis due to its proximity with the pancreas, splenic vessels, and celiac trunk.
Methodology This is a retrospective study conducted in a tertiary care teaching institute. Institutional ethical committee approval was taken for the study. We retrospectively reviewed the last consecutive 100 bariatric surgery cases’ videos operated in our institute. We noted the presence of a posterior gastric vessel. Furthermore, in cases where it was present, it was noted whether the vessel was divided or retracted laterally to achieve the desired configuration of sleeve or micro-pouch in LSG and LRYGB respectively.
* P. Praveen Raj [email protected] Prakhar Gupta [email protected] Shivanshu Misra [email protected] S. Saravana Kumar [email protected] 1
Department of Bariatric Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
Results Out of a total of 100 cases, 63 cases were LSG and 37 were RYGB. A posterior gastric vessel was noted in 88 cas
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