Abstract
Generally, the gold standard of radical surgery for gastrointestinal (GI) tumors is en bloc resection of primary lesions and their related tissues. For gastric cancer, the ideal surgical treatment should be D2 radical gastrectomy plus complete mesogastrium excision. Complete mesogastrium excision is rarely done or mentioned since little is known about the mesogastrium and its presence is still with controversy. Topographically, the “mesogastrium” refers to a peri-gastric structure composed of “fascia propria”, enveloping lymph nodes, blood vessels and adipose tissues, which by connecting to the stomach, suspends from the posterior abdominal wall. In this study, by employing video laparoscopy, a number of proximal segments of dorsal mesogastrium were found being extensively scattered around the pancreas. The structure of the mesogastrium was further identified intraoperatively and then confirmed both grossly and histologically after the operation. Our results demonstrated the existence of mesogastrium (gastric mesentery) and its architecture. We suggest for the first time a “Table model” to describe the relationship between the stomach and gastric mesenteries enveloped by fascia propria, which might provide an improvement in the surgical methods for excision of gastric cancer.
Highlights
The 6 architectural sections of the mesogastrium identified in this study were: (1) the left and (2) right gastroepiploic mesenteries; Figure 1
We could see the smooth surface of the left gastroepiploic mesentery, which lay on the surface of the mesocolon and was covered by fascia propria (Fig. 1b)
No nuclei were found in the fascia propria because the fascia propria contained no subcelluar structures and was a membrane structure comparable to collagenous fibers (Fig. 4b). Through both gross histological observation and laparoscopic examination, this study has found and identified a hitherto unclassified anatomical architecture enveloping the stomach and surrounding adipose tissues, including lymph nodes and the blood vessels which help attach the structures to the posterior abdominal wall
Summary
The 6 architectural sections of the mesogastrium identified in this study were: (1) the left and (2) right gastroepiploic mesenteries; Figure 1. (Figure 1a–d) Cutting off the greater omentum from the left transverse colon and separation from the splenic flexure exposed the space containing Heald’s “angel hairs” (Holy Plane12) clearly revealing the fascia propria covering the smooth layer of the gastroepiploic mesentery on the surface of the mesocolon (Fig. 1a).
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