Vascular anatomy of the gastric tube used for esophageal reconstruction

This study investigates the actual, as contrasted with the presumed, blood supply of the greater curvature gastric tube commonly used to reconstruct the gullet after esophagogastrectomy. Arterial and venous corrosion casts of this tube were created in 30 cadavers and demonstrated the following: (1) The right gastroepiploic artery is the exclusive conduit of blood in the pedicle. (2) The contribution of the right gastric artery is negligible. (3) Although tributaries of the left gastroepiploic artery are distributed over the central portion of the tube, the connection between the right and left gastroepiploic vessels is minute. (4) The blood supply of the cranial 20% of the greater curvature tube is through a microscopic network of capillaries and arterioles. These findings constitute an anatomical argument for extremely gentle handling of the stomach throughout its mobilization, during construction and positioning of the tube, and during the anastomosis.