Surgical anatomy
Introduction
The function of the stomach is to act as a
reservoir for ingested food. It also serves to break down foodstuffs
mechanically and commence the processes of digestion before these products are
passed on into the duodenum. The surgical anatomy must be viewed in this
context.
Blood supply
Arterial supply
The stomach is richly endowed with an arterial
supply on both lesser and great curves (Fig. 51.1). On the lesser curve the left
gastric artery, a branch of the coeliac axis, forms an anastomotic arcade with
the right gastric artery which arises from the common hepatic artery. Branches
of the left gastric artery pass up towards the cardia. The gastroduodenal
artery, which is also a branch of the hepatic artery, passes behind the first
part of the duodenum, highly relevant with respect to the bleeding duodenal ulcer. Here it divides into the superior
pancreaticoduodenal artery and the right gastroepiploic artery. The superior
pancreaticoduodenal artery supplies the duodenum and pancreatic head, and forms
an anastomosis
Veins
In general the veins are equivalent to the
arteries, those along the lesser curve ending in the portal vein and those on
the greater curve joining via the splenic vein. On the lesser curve the coronary
vein is particularly important. It runs up the lesser curve towards the
oesophagus and then passes left to right to join the portal vein. This vein
becomes markedly dilated in portal hypertension.
Lymphatics
The lymphatics of the stomach are of
considerable importance in the surgery of gastric cancer and are therefore
described in detail in that section (later).
Innervation
As with all of the gastrointestinal tract, the
stomach and duodenum possess both intrinsic and extrinsic nerve supplies. The
intrinsic nerves exist principally in two plexuses, the myenteric plexus of
Auerbach and the submucosal plexus of Meissner. Compared with the rest of the
gut the submucosal plexus of the stomach contains relatively few ganglionic
cells