For Treatment of the Upper Area of the Stomach

The important tissue and organs to consider in the upper gastric area in regard to surgery are the liver, abdominal esophagus, spleen, pancreas, transverse colon, and diaphragm. The ligaments that need to be identified are the hepatogastric ligament (lesser omentum), gastropancreatic ligament, gastrosplenic ligament, gastrophrenic ligament, and the gastrocolic ligament (greater omentum) (Fig. 9.1). The principal arteries around the upper area of the stomach are the celiac artery, left gastric artery, splenic artery, left subphrenic artery, posterior gastric artery, left gastroepiploic artery, and short gastric arteries. The important veins are the left gastric (coronary) vein, left gastroepiploic vein, short gastric vein, and splenic vein. In particular, variations in the divergence around the splenic artery must be taken into consideration when performing laparoscopic gastrectomy (Fig. 9.2).