title: Intraoperative Archive of Right Colonic Vascular Variability Aids Central Vascular Ligation and Redefines Gastrocolic Trunk of Henle Variants.
abstract: BACKGROUND
  Vascular supply to the right colon has become an issue because of high variability and subsequent impact on minimally invasive surgery. Past cadaveric or radiologic anatomic assessments are noncomprehensive.
  
  
  OBJECTIVE
  Intraoperative charting of right colonic arteriovenous anatomy was undertaken to determine the incidence and scope of vascular variations.
  
  
  METHODS
  Vascular anatomy variations were documented in snapshot images, captured during laparoscopic video recordings or through open surgical digital photography.
  
  
  METHODS
  Data were drawn from consecutive right hemicolectomies, routinely entailing complete mesocolic excision with central vascular ligation.
  
  
  METHODS
  Seventy patients (mean age, 62.7 years; 37 women (52.8%); 33 men (47.2%)), each with surgically treatable right-sided colon cancer, were prospectively studied.
  
  
  RESULTS
  Both ileocolic and middle colic arteries were regularly identified (100%), with right colic artery present in 41.4% of patients. Ileocolic and middle colic veins consistently drained into the right colon. Although the ileocolic vein always emptied into the superior mesenteric vein, drainage of the middle colic vein was split (superior mesenteric vein, 94.3%; gastrocolic trunk of Henle, 5.3%), as was drainage of the right colic (superior mesenteric vein, 43.3%; gastrocolic trunk of Henle, 56.7%) and accessory middle colic veins (superior mesenteric vein, 54.5%; gastrocolic trunk of Henle, 45.5%), present in 42.9% and 15.7% of patients. Gastrocolic trunk of Henle was found in 88.6% of patients, usually draining into the superior mesenteric vein. No significant sex-related differences were present regarding the incidence and scope of variability displayed by the right colic artery, right colic vein, accessory middle colic vein, or gastrocolic trunk of Henle classification (p > 0.05).
  
  
  CONCLUSIONS
  The inconsistency between cadaver and live surgery anatomy and the low BMI of the Asian population might be drawbacks of our study.
  
  
  CONCLUSIONS
  Variations in right colonic arteriovenous channels, assessed intraoperatively, corroborate those established by cadaveric and radiologic means, prompting a new gastrocolic trunk of Henle classification.
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jamal F
authors.initials: JF
authors.lastname: Alsabilah
authors.forename: Syed A
authors.initials: SA
authors.lastname: Razvi
authors.forename: Mahdi H
authors.initials: MH
authors.lastname: Albandar
authors.forename: Nam K
authors.initials: NK
authors.lastname: Kim
mesh_terms: D063405:Anatomic Variation; D002430:Cecal Neoplasms / Q000601:surgery*; D003082:Colectomy; D003106:Colon / Q000098:blood supply / Q000601:surgery; D044682:Colon, Ascending / Q000098:blood supply* / Q000601:surgery; D044684:Colon, Transverse / Q000098:blood supply* / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D017538:Mesenteric Artery, Superior / Q000033:anatomy & histology*; D008642:Mesenteric Veins / Q000033:anatomy & histology*; D008646:Mesocolon / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies