The Anatomical Study Of Laparoscopic Adjustable Gastric Banding

1. ObjectiveLaparoscopic adjustable gastric banding(LAGB) is considered one of the most preferred surgical option for morbid obesity . The crucial step is to creat the retrogastric tunnel to introduce the adjustable gastric band . However , lack of the tactile sensation and invisibility of the posterior wall of the fundus and cardia of stomach hinder the success of laparoscopic creation of the retrogastric tunnel. The present article was to measure and observe the anatomical structures of the fundus and cardia combining with LAGB , to provide applied anatomical basis for LAGB and to design secure and convenient operation pathways . In addition , by building digitized visible model of the stomach and perigastric structures of the Chinese visible human , the article aimed to provide technique basis for the preoperative simulation of LAGB in the future . 2. Materials and methods(1) Fifteen antisepsis adult specimens were studied for the applied anatomy of LAGB . The anatomical structures of the fundus and cardia were investigated. (2)Computerized 3D reconstruction of the stomach and its surroudings ofthe Chinese visible human was performed on the SGI workstation . 3. Results(1) Applied anatomy of the fundus and cardiaThe end branches of left and right gastric vessel course along lesser curvature and get anastomosed into double vessel arcades with an incidence of 86.7 % .The fundus branch and end branch of left gastric artery course along lesser curvature in an opposite direction and thus one relative avascular region comes into being ,which ranges between the upper anastomosis of the vessel arcades and the beginning of the neighbouring fundus branch . Along lesser curvature this region passes mm wide, and the midpoint is mm below the cardia .Besides left gastric vessel , the blood supply of fundus stomach are two vessels : posterior gastric vessel and short gastric vessels . There are 9 in 15 cases (60% ) of the posterior gastric vessels , which pass through the gastric wall (2.63 0.23) cm away from the cardia . Short gastric vessels go through the gastric wall with a minimum distance about (6.80 1.18) cm away from the cardia .The perigastric structures such as left lobe of liver spleen and the vagus nerve are also investigated .(2) Computerized 3D reconstruction of the stomach and perigastric structuresThe digitized visible model of the stomach and its surroudings was builded successfully on the SGI workstation . All structures reconstructed could be represented individually or jointly and rotated continuously in any plane . Any diameter and angle of the structures reconstructed could be measured conveniently . 4 Conclusions(1)The detailed applied anatomical study in this article can meet the need of surgeons to perform laparoscopic adjustable gastric banding safely and efficiently .(2) The digitized visible model of the stomach and its surroudings posseses a promising prospect for the preoperative simulation of laparoscopic adjustable gastric banding .