Anatomical Knowledge for the Infra-Pyloric Vein Preservation during the Laparoscopy-Assisted Pylorus-Preserving Gastrectomy.

BACKGROUND

Fine anatomical knowledge enables us to use safer laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). Detailed anatomical knowledge of the infra-pyloric vein (IPV) remains obscure. In this study, the aim was to classify the IPV vessel flow.

METHODS

From April 2009 to November 2012, 43 patients with clinical T1 gastric cancer underwent LAPPG with preservation of IPV. Operative videos were retrospectively reviewed, and an anatomical classification of IPV was proposed.

RESULTS

The IPV flow came into the right gastro-epiploic vein (RGEV) and/or the anterior superior pancreaticoduodenal vein (ASPDV). The IPV anatomical flow pattern was classified according to the following 4 types: Type I, the IPV more than 2 flow into RGEV; Type IIa, only 1 IPV into RGEV without into ASPDV; Type IIb, one IPV flow into RGEV and one flow into ASPDV; Type III, IPV only into ASPDV. The proportion of each type was 39.5% (17/43) in Type I, 30.2% (13/43) in Type IIa, 14% (6/43) in Type IIb, and 16.3% (7/43) in Type III.

CONCLUSIONS

The anatomical flow pattern of the IPV was described. It would be beneficial to improve the anatomical knowledge of the IPV for more elaborate and safer lymph node dissection during laparoscopic gastrectomy.