The document summarizes the blood supply and lymphatic drainage of the stomach. It discusses the arterial supply from branches like the left gastric, right gastric, and gastroepiploic arteries. It also discusses the venous drainage which parallels the arterial supply. The lymphatic drainage is described through 4 zones that primarily drain to the celiac nodes. The document provides surgical importance for preserving certain vessels and ligating others in procedures like gastrectomy and splenectomy.

1. MODERATOR: DR S.B.CHOUDHURY
(Assisstant Professor)
PRESENTER: DR MONITOSH PAUL
(First year PGT)
BLOOD SUPPLY AND LYMPHATIC DRAINAGE OF
STOMACH

2.  Brief Anatomy of Stomach
 Arterial Supply
 Venous Drainage
 Lymphatic Drainage

3. Brief Anatomy Of Stomach:
 Occupies left upper
quadrant, epigastric,
and umbilical
regions
 T10 - L3 vertebrae
 Position varies with
bodyhabitus
 greater curvature
lesser curvature
 Cardia, fundus, body,
pylorus

4. Arterial Supply Of Stomach

6. Arteries:
LEFT GASTRIC ARTERY
• 90%-celiac axis,
• 4%-gastrosplenic trunk;
• 3% -direct aortic origin;
• 2%- hepatogastric
trunk.
Branches:
Anterior and posterior
branch before entering the
lesser curvature .

7. RIGHT GASTRIC
ARTERY
 Proper hepatic
artery (50-68%),
 left hepatic artery
(29-40%),
 Common hepatic
artery(3%),
 other less
frequent sources.

8. GASTRODUODENAL
ARTERY
Arises from common
hepatic artery branch of
celiac trunk.
Splanchnic artery
aneurysms of the
gastroduodenal artery are
very rare, and are often
missed preoperatively

9. RIGHT
GASTROEPIPLOIC
ARTERY
• Branch of
gastroduodenal artery.
• Occasionally arises
from superior
mesenteric artery or
anterior superior
pancreaticoduodenal
artery

10. For omental viability during distal gastrectomy,
the right gastroepiploic artery should be
preserved by one of the following methods:
ligating its gastric branches;or
ligating the anterior epiploic; or
ligating the right gastroepiploic distal and
close to the origin of the right epiploic.
Surgical Importance:

11. LEFT GASTROEPIPLOIC ARTERY
 26% Splenic artery directly
 66% from splenic artery by a common stem with
inferior polar splenic branch.
 It is the largest branch of the splenic artery.
 With branches of the right gastroepiploic, form arc
of Barkow.

13. In splenectomy, ligation of the splenic artery
and vein should be located distal to the origin
of the left gastroepiploic vessels.
The splenic vessels should be ligated very
close to their entrance into the spleen to avoid
the postoperative bleeding which follows
ligation proximal to the origin of the left
gastroepiploic artery
Surgical Importance:

14. SHORT GASTRIC ARTERIES
• From Splenic or LGE
• Fundus &
upper part of body
These shorter vessels are the troublemakers in splenectomy,
and careful ligation is done. Imbrication of the greater
curvature is a safety measure, to avoid bleeding, or possible
necrosis with perforation.

15. POSTERIOR GASTRIC
ARTERY
 Proximal, middle, or distal
segment of the splenic
artery.
 Inadvertent ligation or
division of the artery can
cause complications including
focal necrosis and
postoperative haemorrhage.
 The posterior gastric artery
has also been referred to as
the accessory left gastric
artery or ascending
posterior esophagogastric
artery

16. Arteries of distal esophagus and proximal
stomach :

18. ARTERIAL CIRCULATION OF THE GASTRIC WALL AND SURGICAL
IMPORTANCE
• Each of the smaller branches of major arteries perforates
the muscularis of the stomach and supplies the
submucosal plexus.
• Mucosa of the lesser curvature is supplied by small
extrinsic branches of the left and right gastric arteries,
rather than by vessels from the submucosal plexus.
 Ligation of extrinsic arteries will not control bleeding
from gastric ulcer.
 The stomach remains viable after ligation of all arteries
except the right gastroepiploic artery and right gastric
artery.
•

19.  With subtotal gastrectomy, the gastric remnant remains
viable with circulation from left gastroepiploic artery and
the short gastrics, because the left gastric is ligated.
 With 90% to 95% gastrectomy, the remnant stays alive and
well because of the
descending esophageal arteries.
 The blood supply of the proximal gastric pouch depends
on three sources:
Ascending branch of the left gastric artery
Short gastric arteries
Posterior gastric artery (if present)
 Adhesions of the posterior gastric wall must not be cut, as
such adhesions may contain the posterior gastric artery.

20. Venous Drainage is parallel to arterial supply
Rt & Lt gastric veins drain to the portal
Rt gastroepiploic drains to the SMV
Lt gastroepiploic drains to the splenic
Venous Drainage Of Stomach

22. LEFT GASTRIC VEIN
• Bleeding from severed distal branches of the left gastric vein
can be profuse because of the anastomoses between
left gastric, esophageal, and hemiazygos veins.

23. RIGHT GASTRIC VEIN
It travels with the right gastric artery
The prepyloric vein of Mayo is a tributary of the right gastric
vein

24. Major variations in Venous Drainage :
 The inferior mesenteric vein enters the splenic vein in
30%.
 The inferior mesenteric vein enters the superior
mesenteric vein in 30%.
 The inferior mesenteric vein enters the
splenomesenteric junction in 30%.
 The right gastric vein enters the upper portal in 30%.
 The right gastric vein enters the lower portal in 30%.
 The right gastric vein enters the junction in 30%.
 The left gastric vein enters the upper portal in 30%.
 The left gastric vein enters the lower portal in 30%.
 The left gastric vein enters the splenic vein in 30%.

25. RIGHT GASTROEPIPLOIC VEIN
It empties into the superior mesenteric vein in most cases.
Gastrocolic vein (Henle's gastrocolic trunk) is present in 70% of
the cases and it is formed by confluence of the gastroepiploic vein
and right upper colic vein.
The gastrocolic vein is short and is located beneath the root of the
transverse mesocolon, traveling along the anterior surface of the
head of the pancreas.

26. LEFT
GASTROEPIPLOIC
VEIN:
The left gastroepiploic
vein drains into the
splenic vein or into
one of its terminal.
Ligation should be
placed as close as
possible to the hilum
.

27. SHORT GASTRIC VEINS
.
The short gastric vessels should be ligated carefully. They
retract easily and, together with the left gastroepiploic vein, can
be associated with postoperative bleeding.
Drain into the splenic
vein or one of its
branches. Also, these
veins may empty
directly into the
upper part of the
spleen.

29. Lymphatic Drainage of the Stomach:
The 4 zones: I, Inferiorgastric; II, Splenic; III, Superior
gastric IV, Hepatic.

30.  Arrows indicate that most of the drainage finds its way
to the celiac nodes.

31. 1. Left gastric lymph nodes:
drains areas of both
anterior and posterior
gastric walls
2. Pancreaticosplenic nodes:
drains gastric fundus and
body
3. Right gastroepiploic nodes:
drains the right half of the
greater curvature,
occasionally including the
pylorus
4. Hepatic-pyloric-left gastric
nodes: drain the pyloric part
of the stomach

32. •Eight groups of lymph nodes of the stomach:
1. Paracardial nodes
2. Left gastric nodes at the left gastric artery
3. Celiac nodes at the celiac artery
4. Suprapyloric nodes
5. Infrapyloric nodes
6. Right gastroepiploic nodes at the pathway of
the right gastroepiploic artery
7. Pancreaticosplenic nodes at the pathway of
the left gastroepiploic artery
8. Upper greater curvature nodes at the short
gastric vessels

34. Classification of nodal stations in gastric cancer (Japanese
Gastric Cancer Association, 1997):
Anatomical definition of LNs and LN locations
The regional LNs of the stomach are classified into stations numbered from 1 to 20
plus stations 110, 111 and 112.
LN stations 1–12 & 14v - regional stations;
Other LN locations - distant stations
metastases - M1.
LNs No. 16, 19, 10, 110 and 111 - regional LN in case of direct invasion of the
esophagus by the tumor.
LN metastasis (N) classified as
(I) NX: regional LNs cannot be assessed; (II) N0: no regional LNs metastasis; (III)
N1: 1–2 regional LNs metastasis; (IV) N2: 3–6 regional LNs metastasis; and (V) N3:
7 or more regional LNs metastasis (N3a:7–15 regional LNs; N3b: >15 regional LNs).

37. Thank You