The Authors Reply

    loading  Checking for direct PDF access through Ovid

Excerpt

As a result of our large cadaveric dissection study,1 we concluded that normal vascular variations for each vessel of the right colon do not exist, and venous anomalies are especially more common. Thus, it is not possible for 1 person to have exactly the same vascular pattern as another person. Surgeons may encounter this complex vascular anatomy at some stage of surgery. Hence, preoperative evaluation of not only the clinical stage of the cancer but also of the vascular anatomic evaluation of the colon is very useful, especially during complete mesocolic excision with central vascular ligation. Moreover, preoperative radiologic information and the knowledge of these vascular variations are of paramount importance for both removal of the lymphatic tissue around the superior mesenteric vein (SMV) and avoiding serious bleeding complications.
The most critical field of surgery is near the pancreatic notch where the trunk of Henle forms. Venous anomalies are more common at this point, and this area is called the bleeding point. According to the participating gastric, pancreatico-duodenal, and colic vessels, there are many different forms of trunk of Henle. Variations are documented in our series, and no similar pattern was observed among 111 dissections.1 Even the classic description of the Henle was not encountered in this study.
The most common type of trunk of Henle is seen as a gastro-pancreatico-colic trunk (GPCT) with participation of the right gastro-omental vein, anterior superior pancreatico-duodenal veins, and any colic vein. The colic veins run parallel to other veins that participate with the trunk of Henle in the natural position. During the full mobilization of the right side of the colon, inappropriate traction of the mesocolon creates tension on the colic veins and the tributaries of the trunk of Henle (Fig. 1). This may tear any of these colic veins at the attachment point to the GPCT and may result in serious life-threatening bleeding.2
The gastro-pancreatic truncus (GPT) occurs when the colic veins do not join the trunk of Henle. A venous trunk can also drain into the SMV adjacent to the pancreatic notch. However, the situation mentioned above does not occur when the mesocolon is mobilized. Of course, there are possibilities of rupturing all colic veins and tearing of the SMV.
We observed in our cadaveric dissection study that the incidence of GPT and GPCT was 21.6% and 78.4 %.1 Furthermore, we did not detect the classic gastrocolic trunk of Henle.1
The trunk of Henle was found in 46% to 100% of specimens in many studies.3–5 Mostly the trunk was classified as podal (bipod, tripod, or tetrapod) in these studies. However, podal classification does not give information about the draining veins to the trunk. To use the name of the draining veins within each abbreviation might be advantageous, because it describes the anatomy and gives a reminder.1 So, GPCT or GPT is not a simple name, but a critical statement that defines the structure of the trunk of Henle and the effect of surgery.
    loading  Loading Related Articles