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  • Print publication year: 2006
  • Online publication date: December 2009

12 - Upper gastrointestinal surgery

Summary

ANATOMY

Stomach

The upper abdominal viscera can be related to the transpyloric plane. The normal stomach is impalpable with the fundus lying underneath the left diaphragm. The body of a stomach distended secondary to gastric outlet obstruction may be visible and palpable and a succussion splash may be heard within it. Gastric masses are rarely palpable and if at this stage they represent a malignant process, they will invariably be inoperable. The stomach has a rich blood supply which comprises the left gastric artery from the coeliac axis, the right gastric artery from the common hepatic artery, the right gastroepiploic artery from the gastroduodenal branch of the hepatic artery, the left gastroepiploic artery from the splenic artery and the short gastric arteries from the splenic artery. When the stomach is used as a conduit in the chest following oesophagectomy, the left gastric, left gastroepiploic, and short gastric arteries are divided and the organ suffers no ischaemic damage. Corresponding veins drain into the portal venous system and the lymphatic drainage follows perigastric glands and thence to groups around the spleen, aorta, retropancreatic, suprapancreatic, and subpyloric zones.

Oesophagus

The oesophagus is 25 cm long, extending from the pharynx to the cardia. It lies in the posterior mediastinum, and is traditionally divided into upper, middle, and lower thirds. The upper third is closely related anteriorly to the trachea, down to the carina. The middle third extends from the carina to approximately 7 cm above the diaphragmatic hiatus, and is related anteriorly to the pericardium.