Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

Abstract

The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.

Figure 1

Flow diagram of the systematic literature search and study selection according to PRISMA statement.

Figure 2

The anatomical relation between the ileocolic (ICA: A and B images) and right colic (RCA: C and D images) arteries and the superior mesenteric vein (SMV).

Figure 3

Forrest plot presenting pooled prevalence of the Henle trunk presence.

Figure 4

Forrest plot presenting pooled prevalence of the Henle trunk conformations: (a) gastro-colic trunk (GCT); (b) gastro-pancreatic trunk (GPT); (c) gastro-pancreato-colic trunk (GPCT); (d) colo-pancreatic trunk (CPT).

Figure 5

Forrest plot presenting pooled mean value with subgroup analysis (imagistic versus cadaveric) for Henle trunk diameter.

Figure 6

The boundaries of the D3 area (green area) and the frequency of presence for the ileocolic artery (ICA), right colic artery (RCA), and middle colic artery (MCA). It can be observed the ICA and RCA crossing lengths, and the pooled distance between the ICA to RCA origin distance.

Figure 7

Our proposed standardized terminology for Henle trunk surgical anatomy. ASPDV – anterosuperior pancreaticoduodenal vein; RGEV – right gastroepiploic vein; RCV – right colic vein; SRCV – superior right colic vein. To proposed a common terminology for Henle trunk, we grouped all the anatomical variants with a pooled prevalence less than 5.0% in the ‘other’ group of ‘Type VI’. Should be noted that Type I has the highest pooled prevalence, and the Type V the lowest.