Abstract
Due to the increasing incidence of gastrointestinal (GI) tumors, more and more importance is attached to radical resection and patients' survival, which requires adequate extent of resection and radical lymph node dissection. Blood vessels around the gastrointestinal tract, as anatomical landmarks for tumor resection and lymph node dissection, play a key role in the successful surgery and curative treatment of gastrointestinal tumors. In the isolation of subpyloric area or hepatic flexure of the colon for gastrectomy or right hemicolectomy, lymph node dissection and ligation are often performed at the head of the pancreas and superior mesenteric vein, during which even a minor inadvertent error may lead to unwanted bleeding. Among these blood vessels, the venous system composed of Henle's trunk and its tributaries is the most complex, which has a direct influence on the outcome and postoperative recovery of the patients. There are many variations of Henle's trunk, with complicated courses and various locations, attracting more and more researchers to study it and tried to analyze the influence of its variations on gastrointestinal surgeries. We characterized various variants and tributaries of Henle's trunk using autopsy, vascular casting, 3D CT reconstruction, intraoperative anatomy, and Hisense CAS system and summarized and analyzed the tributaries of Henle's trunk, to determine its influence on GI surgeries.
Highlights
Resection of tumor along blood vessels and lymph node dissection has been the basic procedures in the surgical treatment of GI tumors
It is a venous trunk, later known as Henle’s trunk or Henle’s gastrocolic trunk (GTH), connecting part of the blood supply to the stomach and colon, which is formed by the convergence of the stomach-draining right gastroepiploic vein (RGEV) and the colon-draining superior right colic vein (SRCV), and drains into the superior mesenteric vein (SMV) at the inferior border of the pancreas
We classified Henle’s trunk into 2 types and 10 subtypes, and the most common one is those formed by SRCV, as a colic tributary, and GEV and anterior superior pancreaticoduodenal vein (ASPDV), which is found in 31.4% of all patients (Table 4)
Summary
Resection of tumor along blood vessels and lymph node dissection has been the basic procedures in the surgical treatment of GI tumors. Understanding of the anatomy and variations of the blood vessels determines the result of the surgery and prognosis of the patients. Henle’s trunk has attracted more and more attention because of its special anatomical position and the role as an anatomical landmark in GI surgeries, and more and more studies were done on it. Various methods have been employed to identify the course and variations of Henle’s trunk usage, suggesting its clinical importance and variability and complexity. This study reviewed the definition, construction, variations, and significance in gastrocolic surgeries of Henle’s trunk
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