[The left gastroepiploic artery: a splenic origin but a variable birthplace]. / L'artère gastro-omentale gauche : une origine splénique mais un niveau de naissance variable.

ABSTRACT

The left gastroepiploic artery (LGEA) is rarely described. The aim of this study is to report the fashion of its origin considering the greatly surgical interest of the short gastric vessels in the spleen-preserving distal pancreatectomy with excision of splenic pedicle. About 79 fresh cadaveric pieces we dissect and opacified the LGEA to specify its origin based on the Pinus's classification. We measured the distances between the origin of the LGEA and the terminal division of the splenic artery, the splenic hilus and the great gastric curvature. The LGEA arise from the splenic artery. Dissection underlines a troncular origin (type I) in 20.25% of cases, a distal origin from an inferior polar branch (type II) in 68.35% of cases and an origin from a common spleno-gastroepiploic trunk (type III) in 11.4% of cases. The three distances measured was respectively of 28.7, 25.3 and 31.4mm. The arteriography revealed respectively for the same types 21.21, 51.51 and 27.28%. The vascular disposition of the type III well illustrates the important role of the LGEA for the vascularization of the inferior pole of the spleen. Although the LGEA arise from a polar splenic lower branch in more half of the cases, it is important to know the frequency of the other modalities of its origin. These anatomical variations vascular are to be considered during spleen-preserving distal pancreatectomy with excision of splenic pedicle as well as for gastric esophagoplasty.